[House Report 116-514]
[From the U.S. Government Publishing Office]


116th Congress    }                                   {        Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                   {        116-514

======================================================================



 
            MATERNAL HEALTH QUALITY IMPROVEMENT ACT OF 2019

                                _______
                                

 September 17, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 4995]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4995) to amend the Public Health Service Act to 
improve obstetric care and maternal health outcomes, and for 
other purposes, having considered the same, reports favorably 
thereon with an amendment and recommends that the bill as 
amended do pass.

                                CONTENTS

                                                                   Page
   I. Purpose and Summary.............................................8
  II. Background and Need for the Legislation.........................9
 III. Committee Hearings.............................................12
  IV. Committee Consideration........................................12
   V. Committee Votes................................................13
  VI. Oversight Findings.............................................13
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditur13
VIII. Congressional Budget Office Estimate...........................13
  IX. Federal Mandates Statement.....................................15
   X. Statement of General Performance Goals and Objectives..........15
  XI. Duplication of Federal Programs................................15
 XII. Committee Cost Estimate........................................15
XIII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits....16
 XIV. Advisory Committee Statement...................................16
  XV. Applicability to Legislative Branch............................16
 XVI. Section-by-Section Analysis of the Legislation.................16
XVII. Changes in Existing Law Made by the Bill, as Reported..........20

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Maternal Health Quality Improvement 
Act of 2019''.

SEC. 2. TABLE OF CONTENTS.

  The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

            TITLE I--IMPROVING OBSTETRIC CARE IN RURAL AREAS

Sec. 101. Improving rural maternal and obstetric care data.
Sec. 102. Rural obstetric network grants.
Sec. 103. Telehealth network and telehealth resource centers grant 
programs.
Sec. 104. Rural maternal and obstetric care training demonstration.
Sec. 105. GAO report.

             TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE

Sec. 201. Innovation for maternal health.
Sec. 202. Training for health care providers.
Sec. 203. Study on training to reduce and prevent discrimination.
Sec. 204. Perinatal quality collaboratives.
Sec. 205. Integrated services for pregnant and postpartum women.

            TITLE I--IMPROVING OBSTETRIC CARE IN RURAL AREAS

SEC. 101. IMPROVING RURAL MATERNAL AND OBSTETRIC CARE DATA.

  (a) Maternal Mortality and Morbidity Activities.--Section 301 of the 
Public Health Service Act (42 U.S.C. 241) is amended--
          (1) by redesignating subsections (e) through (h) as 
        subsections (f) through (i), respectively; and
          (2) by inserting after subsection (d), the following:
  ``(e) The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, shall expand, intensify, and coordinate 
the activities of the Centers for Disease Control and Prevention with 
respect to maternal mortality and morbidity.''.
  (b) Office of Women's Health.--Section 310A(b)(1) of the Public 
Health Service Act (42 U.S.C. 242s(b)(1)) is amended by inserting 
``sociocultural, including among American Indians and Alaska Natives, 
as such terms are defined in section 4 of the Indian Health Care 
Improvement Act, geographic,'' after ``biological,''.
  (c) Safe Motherhood.--Section 317K of the Public Health Service Act 
(42 U.S.C. 247b-12) is amended--
          (1) in subsection (a)(2)(A), by inserting before the period 
        at the end the following: ``, including improving collection of 
        data on race, ethnicity, and other demographic information''; 
        and
          (2) in subsection (b)(2)--
                  (A) in subparagraph (L), by striking ``and'' at the 
                end;
                  (B) by redesignating subparagraph (M) as subparagraph 
                (N); and
                  (C) by inserting after subparagraph (L), the 
                following:
                  ``(M) an examination of the relationship between 
                maternal and obstetric services in rural areas and 
                outcomes in delivery and postpartum care; and''.
  (d) Office of Research on Women's Health.--Section 486 of the Public 
Health Service Act (42 U.S.C. 287d) is amended--
          (1) in subsection (b), by amending paragraph (3) to read as 
        follows:
          ``(3) carry out paragraphs (1) and (2) with respect to--
                  ``(A) the aging process in women, with priority given 
                to menopause; and
                  ``(B) pregnancy, with priority given to deaths 
                related to pregnancy;''; and
          (2) in subsection (d)(4)(A)(iv), by inserting ``, including 
        maternal mortality and other maternal morbidity outcomes'' 
        before the semicolon.

SEC. 102. RURAL OBSTETRIC NETWORK GRANTS.

  The Public Health Service Act is amended by inserting after section 
330A-1 of such Act (42 U.S.C. 254c-1a) the following:

``SEC. 330A-2. RURAL OBSTETRIC NETWORK GRANTS.

  ``(a) Program Established.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, 
shall award grants to eligible entities to establish collaborative 
improvement and innovation networks (referred to in this section as 
`rural obstetric networks') to improve birth outcomes and reduce 
maternal morbidity and mortality by improving maternity care and access 
to care in rural areas, frontier areas, maternity care health 
professional target areas, and Indian country and with Indian Tribes 
and tribal organizations.
  ``(b) Use of Funds.--Rural obstetric networks receiving funds 
pursuant to this section may use such funds to--
          ``(1) assist pregnant women and individuals in areas and 
        within populations referenced in subsection (a) with accessing 
        and utilizing maternal and obstetric care, including 
        preconception, pregnancy, labor and delivery, postpartum, and 
        interconception services to improve outcomes in birth and 
        maternal mortality and morbidity;
          ``(2) identify successful delivery models for maternal and 
        obstetric care (including preconception, pregnancy, labor and 
        delivery, postpartum, and interconception services) for 
        individuals in areas and within populations referenced by 
        subsection (a), including evidence-based home visiting programs 
        and successful, culturally competent models with positive 
        maternal health outcomes that advance health equity;
          ``(3) develop a model for collaboration between health 
        facilities that have an obstetric care unit and health 
        facilities that do not have an obstetric care unit to improve 
        access to and the delivery of obstetric services in communities 
        lacking these services;
          ``(4) provide training and guidance on obstetric care for 
        health facilities that do not have obstetric care units;
          ``(5) collaborate with academic institutions that can provide 
        regional expertise and research on access, outcomes, needs 
        assessments, and other identified data and measurement 
        activities needed to inform rural obstetric network efforts to 
        improve obstetric care; and
          ``(6) measure and address inequities in birth outcomes among 
        rural residents, with an emphasis on racial and ethnic 
        minorities and underserved populations.
  ``(c) Definitions.--In this section:
          ``(1) Eligible entities.--The term `eligible entities' means 
        entities providing obstetric, gynecologic, and other maternal 
        health care services in rural areas, frontier areas, or 
        medically underserved areas, or to medically underserved 
        populations or Native Americans, including Indian tribes or 
        tribal organizations.
          ``(2) Frontier area.--The term `frontier area' means a 
        frontier county, as defined in section 1886(d)(3)(E)(iii)(III) 
        of the Social Security Act.
          ``(3) Indian country.--The term `Indian country' has the 
        meaning given such term in section 1151 of title 18, United 
        States Code.
          ``(4) Maternity care health professional target area.--The 
        term `maternity care health professional target area' has the 
        meaning of such term as used in section 332(k)(2).
          ``(5) Rural area.--The term `rural area' has the meaning 
        given that term in section 1886(d)(2) of the Social Security 
        Act.
          ``(6) Indian tribes; tribal organization.--The terms `Indian 
        Tribe' and `tribal organization' have the meaning given such 
        terms in section 4 of the Indian Self-Determination and 
        Education Assistance Act.
  ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $3,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 103. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT 
                    PROGRAMS.

  Section 330I of the Public Health Service Act (42 U.S.C. 254c-14) is 
amended--
          (1) in subsection (f)(1)(B)(iii), by adding at the end the 
        following:
                                  ``(XIII) Providers of maternal, 
                                including prenatal, labor and birth, 
                                and postpartum care services and 
                                entities operating obstetric care 
                                units.''; and
          (2) in subsection (i)(1)(B), by inserting ``labor and birth, 
        postpartum,'' before ``or prenatal''.

SEC. 104. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

  Subpart 1 of part E of title VII of the Public Health Service Act is 
amended by inserting after section 760 (42 U.S.C. 294n et seq.), as 
amended by section 202, is amended by adding at the end the following:

``SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

  ``(a) In General.--The Secretary shall establish a training 
demonstration program to award grants to eligible entities to support--
          ``(1) training for physicians, medical residents, including 
        family medicine and obstetrics and gynecology residents, and 
        fellows to practice maternal and obstetric medicine in rural 
        community-based settings;
          ``(2) training for nurse practitioners, physician assistants, 
        nurses, certified nurse midwives, home visiting nurses and non-
        clinical home visiting workforce professionals and 
        paraprofessionals, or non-clinical professionals, who meet 
        applicable State training and licensing requirements, to 
        provide maternal care services in rural community-based 
        settings; and
          ``(3) establishing, maintaining, or improving academic units 
        or programs that--
                  ``(A) provide training for students or faculty, 
                including through clinical experiences and research, to 
                improve maternal care in rural areas; or
                  ``(B) develop evidence-based practices or 
                recommendations for the design of the units or programs 
                described in subparagraph (A), including curriculum 
                content standards.
  ``(b) Activities.--
          ``(1) Training for medical residents and fellows.--A 
        recipient of a grant under subsection (a)(1)--
                  ``(A) shall use the grant funds--
                          ``(i) to plan, develop, and operate a 
                        training program to provide obstetric care in 
                        rural areas for family practice or obstetrics 
                        and gynecology residents and fellows; or
                          ``(ii) to train new family practice or 
                        obstetrics and gynecology residents and fellows 
                        in maternal and obstetric health care to 
                        provide and expand access to maternal and 
                        obstetric health care in rural areas; and
                  ``(B) may use the grant funds to provide additional 
                support for the administration of the program or to 
                meet the costs of projects to establish, maintain, or 
                improve faculty development, or departments, divisions, 
                or other units necessary to implement such training.
          ``(2) Training for other providers.--A recipient of a grant 
        under subsection (a)(2)--
                  ``(A) shall use the grant funds to plan, develop, or 
                operate a training program to provide maternal health 
                care services in rural, community-based settings; and
                  ``(B) may use the grant funds to provide additional 
                support for the administration of the program or to 
                meet the costs of projects to establish, maintain, or 
                improve faculty development, or departments, divisions, 
                or other units necessary to implement such program.
          ``(3) Training program requirements.--The recipient of a 
        grant under subsection (a)(1) or (a)(2) shall ensure that 
        training programs carried out under the grant are evidence-
        based and include instruction on--
                  ``(A) maternal mental health, including perinatal 
                depression and anxiety;
                  ``(B) maternal substance use disorder;
                  ``(C) social determinants of health that impact 
                individuals living in rural communities, including 
                poverty, social isolation, access to nutrition, 
                education, transportation, and housing; and
                  ``(D) implicit bias.
  ``(c) Eligible Entities.--
          ``(1) Training for medical residents and fellows.--To be 
        eligible to receive a grant under subsection (a)(1), an entity 
        shall--
                  ``(A) be a consortium consisting of--
                          ``(i) at least one teaching health center; or
                          ``(ii) the sponsoring institution (or parent 
                        institution of the sponsoring institution) of--
                                  ``(I) an obstetrics and gynecology or 
                                family medicine residency program that 
                                is accredited by the Accreditation 
                                Council of Graduate Medical Education 
                                (or the parent institution of such a 
                                program); or
                                  ``(II) a fellowship in maternal or 
                                obstetric medicine, as determined 
                                appropriate by the Secretary; or
                  ``(B) be an entity described in subparagraph (A)(ii) 
                that provides opportunities for medical residents or 
                fellows to train in rural community-based settings.
          ``(2) Training for other providers.--To be eligible to 
        receive a grant under subsection (a)(2), an entity shall be--
                  ``(A) a teaching health center (as defined in section 
                749A(f));
                  ``(B) a federally qualified health center (as defined 
                in section 1905(l)(2)(B) of the Social Security Act);
                  ``(C) a community mental health center (as defined in 
                section 1861(ff)(3)(B) of the Social Security Act);
                  ``(D) a rural health clinic (as defined in section 
                1861(aa) of the Social Security Act);
                  ``(E) a freestanding birth center (as defined in 
                section 1905(l)(3) of the Social Security Act); or
                  ``(F) an Indian Health Program or a Native Hawaiian 
                health care system (as such terms are defined in 
                section 4 of the Indian Health Care Improvement Act and 
                section 12 of the Native Hawaiian Health Care 
                Improvement Act, respectively).
          ``(3) Academic units or programs.--To be eligible to receive 
        a grant under subsection (a)(3), an entity shall be a school of 
        medicine, a school of osteopathic medicine, a school of nursing 
        (as defined in section 801), a physician assistant education 
        program, an accredited public or nonprofit private hospital, an 
        accredited medical residency training program, a school 
        accredited by the Midwifery Education and Accreditation 
        Council, by the Accreditation Commission for Midwifery 
        Education, or by the American Midwifery Certification Board, or 
        a public or private nonprofit educational entity which the 
        Secretary has determined is capable of carrying out such grant.
          ``(4) Application.--To be eligible to receive a grant under 
        subsection (a), an entity shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require, including an estimate 
        of the amount to be expended to conduct training activities 
        under the grant (including ancillary and administrative costs).
  ``(d) Study and Report.--
          ``(1) Study.--
                  ``(A) In general.--The Secretary, acting through the 
                Administrator of the Health Resources and Services 
                Administration, shall conduct a study on the results of 
                the demonstration program under this section.
                  ``(B) Data submission.--Not later than 90 days after 
                the completion of the first year of the training 
                program, and each subsequent year for the duration of 
                the grant, that the program is in effect, each 
                recipient of a grant under subsection (a) shall submit 
                to the Secretary such data as the Secretary may require 
                for analysis for the report described in paragraph (2).
          ``(2) Report to congress.--Not later than 1 year after 
        receipt of the data described in paragraph (1)(B), the 
        Secretary shall submit to the Committee on Energy and Commerce 
        of the House of Representatives and the Committee on Health, 
        Education, Labor, and Pensions of the Senate a report that 
        includes--
                  ``(A) an analysis of the effect of the demonstration 
                program under this section on the quality, quantity, 
                and distribution of maternal (including prenatal, labor 
                and birth, and postpartum) care services and the 
                demographics of the recipients of those services;
                  ``(B) an analysis of maternal and infant health 
                outcomes (including quality of care, morbidity, and 
                mortality) before and after implementation of the 
                program in the communities served by entities 
                participating in the demonstration; and
                  ``(C) recommendations on whether the demonstration 
                program should be expanded.
  ``(e) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 105. GAO REPORT.

  Not later than 18 months after the date of enactment of this Act, the 
Comptroller General of the United States shall submit to the Committee 
on Energy and Commerce of the House of Representatives and the 
Committee on Health, Education, Labor, and Pensions of the Senate a 
report on maternal care in rural areas, including prenatal, labor and 
birth, and postpartum care in rural areas. Such report shall include 
the following:
          (1) Trends in data that may identify potential gaps in 
        maternal and obstetric clinicians and health professionals, 
        including non-clinical professionals.
          (2) Trends in the number of facilities able to provide 
        maternal care, including prenatal, labor and birth, and 
        postpartum care, in rural areas, including care for high-risk 
        pregnancies.
          (3) The gaps in data on maternal mortality and morbidity and 
        recommendations to standardize the format on collecting data 
        related to maternal mortality and morbidity.
          (4) The gaps in maternal health outcomes by race and 
        ethnicity in rural communities, with a focus on racial 
        inequities for residents who are racial and ethnic minorities 
        or members of underserved populations.
          (5) An examination of--
                  (A) activities which the Secretary of Health and 
                Human Services plans to conduct to improve maternal 
                care in rural areas, including prenatal, labor and 
                birth, and postpartum care; and
                  (B) the extent to which the Secretary has a plan for 
                completing these activities, has identified the lead 
                agency responsible for each activity, has identified 
                any needed coordination among agencies, and has 
                developed a budget for conducting such activities.
          (6) Other information that the Comptroller General determines 
        appropriate.

             TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE

SEC. 201. INNOVATION FOR MATERNAL HEALTH.

  The Public Health Service Act is amended--
          (1) in the section designation of section 330M (42 U.S.C. 
        254c-19) by inserting a period after ``330M''; and
          (2) by inserting after such section 330M the following:

``SEC. 330N. INNOVATION FOR MATERNAL HEALTH.

  ``(a) In General.--The Secretary, in consultation with experts 
representing a variety of clinical specialties, State, tribal, or local 
public health officials, researchers, epidemiologists, statisticians, 
and community organizations, shall establish or continue a program to 
award competitive grants to eligible entities for the purpose of--
          ``(1) identifying, developing, or disseminating best 
        practices to improve maternal health care quality and outcomes, 
        eliminate preventable maternal mortality and severe maternal 
        morbidity, and improve infant health outcomes, which may 
        include--
                  ``(A) information on evidence-based practices to 
                improve the quality and safety of maternal health care 
                in hospitals and other health care settings of a State 
                or health care system, including by addressing topics 
                commonly associated with health complications or risks 
                related to prenatal care, labor care, birthing, and 
                postpartum care;
                  ``(B) best practices for improving maternal health 
                care based on data findings and reviews conducted by a 
                State maternal mortality review committee that address 
                topics of relevance to common complications or health 
                risks related to prenatal care, labor care, birthing, 
                and postpartum care; and
                  ``(C) information on addressing determinants of 
                health that impact maternal health outcomes for women 
                before, during, and after pregnancy;
          ``(2) collaborating with State maternal mortality review 
        committees to identify issues for the development and 
        implementation of evidence-based practices to improve maternal 
        health outcomes and reduce preventable maternal mortality and 
        severe maternal morbidity;
          ``(3) providing technical assistance and supporting the 
        implementation of best practices identified in paragraph (1) to 
        entities providing health care services to pregnant and 
        postpartum women; and
          ``(4) identifying, developing, and evaluating new models of 
        care that improve maternal and infant health outcomes, which 
        may include the integration of community-based services and 
        clinical care.
  ``(b) Eligible Entities.--To be eligible for a grant under subsection 
(a), an entity shall--
          ``(1) submit to the Secretary an application at such time, in 
        such manner, and containing such information as the Secretary 
        may require; and
          ``(2) demonstrate in such application that the entity is 
        capable of carrying out data-driven maternal safety and quality 
        improvement initiatives in the areas of obstetrics and 
        gynecology or maternal health.
  ``(c) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $10,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 202. TRAINING FOR HEALTH CARE PROVIDERS.

  Title VII of the Public Health Service Act is amended by striking 
section 763 (42 U.S.C. 294p) and inserting the following:

``SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS.

  ``(a) Grant Program.--The Secretary shall establish a program to 
award grants to accredited schools of allopathic medicine, osteopathic 
medicine, and nursing, and other health professional training programs 
for the training of health care professionals to reduce and prevent 
discrimination (including training related to implicit and explicit 
biases) in the provision of health care services related to prenatal 
care, labor care, birthing, and postpartum care.
  ``(b) Eligibility.--To be eligible for a grant under subsection (a), 
an entity described in such subsection shall submit to the Secretary an 
application at such time, in such manner, and containing such 
information as the Secretary may require.
  ``(c) Reporting Requirement.--Each entity awarded a grant under this 
section shall periodically submit to the Secretary a report on the 
status of activities conducted using the grant, including a description 
of the impact of such training on patient outcomes, as applicable.
  ``(d) Best Practices.--The Secretary may identify and disseminate 
best practices for the training of health care professionals to reduce 
and prevent discrimination (including training related to implicit and 
explicit biases) in the provision of health care services related to 
prenatal care, labor care, birthing, and postpartum care.
  ``(e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $5,000,000 for each of fiscal 
years 2020 through 2024.''.

SEC. 203. STUDY ON TRAINING TO REDUCE AND PREVENT DISCRIMINATION.

  Not later than 2 years after date of enactment of this Act, the 
Secretary of Health and Human Services (referred to in this section as 
the ``Secretary'') shall, through a contract with an independent 
research organization, conduct a study and make recommendations for 
accredited schools of allopathic medicine, osteopathic medicine, and 
nursing, and other health professional training programs, on best 
practices related to training to reduce and prevent discrimination, 
including training related to implicit and explicit biases, in the 
provision of health care services related to prenatal care, labor care, 
birthing, and postpartum care.

SEC. 204. PERINATAL QUALITY COLLABORATIVES.

  (a) Grants.--Section 317K(a)(2) of the Public Health Service Act (42 
U.S.C. 247b-12(a)(2)) is amended by adding at the end the following:
                  ``(E)(i) The Secretary, acting through the Director 
                of the Centers for Disease Control and Prevention and 
                in coordination with other offices and agencies, as 
                appropriate, shall establish or continue a competitive 
                grant program for the establishment or support of 
                perinatal quality collaboratives to improve perinatal 
                care and perinatal health outcomes for pregnant and 
                postpartum women and their infants. A State, Indian 
                Tribe, or tribal organization may use funds received 
                through such grant to--
                          ``(I) support the use of evidence-based or 
                        evidence-informed practices to improve outcomes 
                        for maternal and infant health;
                          ``(II) work with clinical teams; experts; 
                        State, local, and, as appropriate, tribal 
                        public health officials; and stakeholders, 
                        including patients and families, to identify, 
                        develop, or disseminate best practices to 
                        improve perinatal care and outcomes; and
                          ``(III) employ strategies that provide 
                        opportunities for health care professionals and 
                        clinical teams to collaborate across health 
                        care settings and disciplines, including 
                        primary care and mental health, as appropriate, 
                        to improve maternal and infant health outcomes, 
                        which may include the use of data to provide 
                        timely feedback across hospital and clinical 
                        teams to inform responses, and to provide 
                        support and training to hospital and clinical 
                        teams for quality improvement, as appropriate.
                  ``(ii) To be eligible for a grant under clause (i), 
                an entity shall submit to the Secretary an application 
                in such form and manner and containing such information 
                as the Secretary may require.''.
  (b) Authorization of Appropriations.--Section 317K(f) of the Public 
Health Service Act (42 U.S.C. 247b-12(f)) is amended by striking 
``$58,000,000 for each of fiscal years 2019 through 2023'' and 
inserting ``$65,000,000 for each of fiscal years 2020 through 2024''.

SEC. 205. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.

  (a) Grants.--The Public Health Service Act is amended by inserting 
after section 330N of such Act, as added by section 201, the following:

``SEC. 330O. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.

  ``(a) In General.--The Secretary may award grants for the purpose of 
establishing or operating evidence-based or innovative, evidence-
informed programs to deliver integrated health care services to 
pregnant and postpartum women to optimize the health of women and their 
infants, including--
          ``(1) to reduce adverse maternal health outcomes, pregnancy-
        related deaths, and related health disparities (including such 
        disparities associated with racial and ethnic minority 
        populations); and
          ``(2) as appropriate, by addressing issues researched under 
        section 317K(b)(2).
  ``(b) Integrated Services for Pregnant and Postpartum Women.--
          ``(1) Eligibility.--To be eligible to receive a grant under 
        subsection (a), a State, Indian Tribe, or tribal organization 
        (as such terms are defined in section 4 of the Indian Self-
        Determination and Education Assistance Act) shall work with 
        relevant stakeholders that coordinate care (including 
        coordinating resources and referrals for health care and social 
        services) to develop and carry out the program, including--
                  ``(A) State, Tribal, and local agencies responsible 
                for Medicaid, public health, social services, mental 
                health, and substance use disorder treatment and 
                services;
                  ``(B) health care providers who serve pregnant and 
                postpartum women; and
                  ``(C) community-based health organizations and health 
                workers, including providers of home visiting services 
                and individuals representing communities with 
                disproportionately high rates of maternal mortality and 
                severe maternal morbidity, and including those 
                representing racial and ethnicity minority populations.
          ``(2) Terms.--
                  ``(A) Period.--A grant awarded under subsection (a) 
                shall be made for a period of 5 years. Any supplemental 
                award made to a grantee under subsection (a) may be 
                made for a period of less than 5 years.
                  ``(B) Preference.--In awarding grants under 
                subsection (a), the Secretary shall--
                          ``(i) give preference to States, Indian 
                        Tribes, and tribal organizations that have the 
                        highest rates of maternal mortality and severe 
                        maternal morbidity relative to other such 
                        States, Indian Tribes, or tribal organizations, 
                        respectively; and
                          ``(ii) shall consider health disparities 
                        related to maternal mortality and severe 
                        maternal morbidity, including such disparities 
                        associated with racial and ethnic minority 
                        populations.
                  ``(C) Priority.--In awarding grants under subsection 
                (a), the Secretary shall give priority to applications 
                from up to 15 entities described in subparagraph 
                (B)(i).
                  ``(D) Evaluation.--The Secretary shall require 
                grantees to evaluate the outcomes of the programs 
                supported under the grant.
  ``(c) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $15,000,000 for each of fiscal 
years 2020 through 2024.''.
  (b) Report on Grant Outcomes and Dissemination of Best Practices.--
          (1) Report.--Not later than February 1, 2026, the Secretary 
        of Health and Human Services shall submit to the Committee on 
        Energy and Commerce of the House of Representatives and the 
        Committee on Health, Education, Labor, and Pensions of the 
        Senate a report that describes--
                  (A) the outcomes of the activities supported by the 
                grants awarded under the amendments made by this 
                section on maternal and child health;
                  (B) best practices and models of care used by 
                recipients of grants under such amendments; and
                  (C) obstacles identified by recipients of grants 
                under such amendments, and strategies used by such 
                recipients to deliver care, improve maternal and child 
                health, and reduce health disparities.
          (2) Dissemination of best practices.--Not later than August 
        1, 2026, the Secretary of Health and Human Services shall 
        disseminate information on best practices and models of care 
        used by recipients of grants under section 330O of the Public 
        Health Service Act (as added by this section) (including best 
        practices and models of care relating to the reduction of 
        health disparities, including such disparities associated with 
        racial and ethnic minority populations, in rates of maternal 
        mortality and severe maternal morbidity) to relevant 
        stakeholders, which may include health providers, medical 
        schools, nursing schools, relevant State, tribal, and local 
        agencies, and the general public.

                         I. Purpose and Summary

    H.R. 4995, the ``Maternal Health Quality Improvement Act of 
2019'', was introduced on November 8, 2019, by Representatives 
Eliot L. Engel (D-NY), Larry Bucshon (R-IN), Xochitl Torres 
Small (D-NM), Robert E. Latta (R-OH), Alma S. Adams (D-NC), and 
Steve Stivers (R-OH). H.R. 4995 authorizes public health 
programs designed to improve maternal health outcomes, 
including initiatives that: enhance data collection and 
coordination of health services in rural areas; expand the use 
of telehealth services for maternal health care; train health 
providers in rural areas; provide innovation in maternal health 
grants; train providers on how to reduce racial disparities in 
maternal health outcomes; provide grants for perinatal quality 
collaboratives; and integrate services for pregnant and 
postpartum women to reduce adverse maternal health outcomes.

                II. Background and Need for Legislation

    According to the Centers for Disease Control and Prevention 
(CDC), women in the United States are more likely to die from 
childbirth or pregnancy-related causes than other women in the 
developed world, with about 700 women dying every year from 
pregnancy-related complications.\1\\2\ More details are needed 
to better understand the actual causes of death, but research 
suggests that approximately three in every five pregnancy-
related deaths are preventable.\3\ The deaths are roughly 
evenly split between those that occur during pregnancy (31 
percent of deaths), during delivery or in the week after 
delivery (36 percent of deaths), and between one week and one 
year postpartum (33 percent of deaths).\4\
---------------------------------------------------------------------------
    \1\Centers for Disease Control and Prevention, Vital Signs: 
Pregnancy-related Deaths: Saving Women's Lives, Before, During and 
After Delivery (https://www.cdc.gov/vitalsigns/maternal-deaths/
index.html) (May 7, 2019).
    \2\Centers for Disease Control and Prevention, Pregnancy Related 
Deaths (https://www.cdc.gov/reproductivehealth/maternalinfanthealth/
pregnancy-relatedmortality.htm) (Feb. 26, 2019).
    \3\Centers for Disease Control and Prevention, Vital Signs: 
Pregnancy-related Deaths: Saving Women's Lives, Before, During and 
After Delivery (https://www.cdc.gov/vitalsigns/maternal-deaths/
index.html) (May 7, 2019).
    \4\Id.
---------------------------------------------------------------------------
    Causes of pregnancy-related deaths differ throughout 
pregnancy and after delivery. Heart disease and stroke cause 
the most deaths overall, while obstetric emergencies, such as 
severe bleeding and amniotic fluid embolism cause the most 
deaths at delivery.\5\ Severe bleeding, high blood pressure, 
and infection are the leading causes of death in the week after 
delivery, and weakened heart muscle is the leading cause of 
deaths one week to one year postpartum.\6\ Observers have also 
noted postpartum depression as a common condition in postpartum 
women, with suicide among the leading causes of death in 
postpartum women.\7\
---------------------------------------------------------------------------
    \5\Id.
    \6\Id.
    \7\Dorothy Sit et al., Suicidal Ideation in Depressed Postpartum 
Women: Associations with Childhood Trauma, Sleep Disturbance and 
Anxiety, 66 J. Psychiatric Research 95 (2015).
---------------------------------------------------------------------------
    In addition to high rates of maternal mortality, rates of 
severe maternal morbidity (SMM) are on the rise. SMM is defined 
as a condition that includes unexpected outcomes of labor and 
delivery that result in significant short- or long-term 
consequences to a woman's health. As tracked by the CDC, the 
rate of overall SMM rose nearly 200 percent between 1993 and 
2014, with most women with a SMM requiring blood transfusion, 
but others requiring hysterectomy and ventilation or a 
temporary tracheostomy.\8\
---------------------------------------------------------------------------
    \8\Id.
---------------------------------------------------------------------------
    Across nearly all causes of maternal mortality and 
morbidity, there are significant and pervasive racial 
disparities. Though literature has not fully explained all of 
the factors contributing to racial disparities in maternal 
health outcomes, statistics show non-Hispanic black and 
American Indian/Alaska Native women are about three times more 
likely to die from pregnancy-related causes than White 
women.\9\ For women over the age of 30, pregnancy-related 
mortality for Black and American Indian/Alaska Native women is 
four to five times higher than it is for White women.\10\ These 
disparities persist despite education level and socioeconomic 
status.\11\ For example, the data show that pregnancy-related 
deaths for Black and American Indian/Alaska Native women with 
some college education were higher than those for all other 
racial/ethnic groups with less than a high school diploma.\12\ 
To address these disparities, CDC has recommended that 
hospitals and health care systems implement standardized 
protocols in quality improvement initiatives, especially among 
facilities that serve disproportionately affected communities. 
CDC has also encouraged hospitals and health systems to 
identify and address implicit biases in health care in order to 
improve patient-provider interactions, health communication, 
and health outcomes.\13\
---------------------------------------------------------------------------
    \9\Id.
    \10\Centers for Disease Control and Prevention, Racial and Ethnic 
Disparities Continue in Pregnancy-Related Deaths (https://www.cdc.gov/
media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-
deaths.html) (Sept. 5, 2019).
    \11\Elizabeth A. Howell, Reducing Disparities in Severe Maternal 
Morbidity and Mortality, 61 Clinical Obstetrics and Gynecology 387 
(June 2018).
    \12\Emely E. Petersen et al., Racial/Ethnic Disparities in 
Pregnancy-Related Deaths--United States, 2007-2016, 68 Morbidity and 
Mortality Weekly Report 762 (available at https://www.cdc.gov/mmwr/
volumes/68/wr/mm6835a3.htm?s_cid=mm6835a3_w) (Sept. 6, 2019).
    \13\See note 9.
---------------------------------------------------------------------------
    Pregnant women in rural areas also face higher negative 
health outcomes. While the maternal mortality rate in urban 
areas was 18.2 maternal deaths per 100,000 live births in 2015, 
very rural areas had a maternal death rate of 29.4 per 100,000 
live births.\14\ Almost half of rural counties in the United 
States do not have a hospital with obstetric services, which 
means that most rural women do not have access to perinatal 
services within a 30-minute drive, and more than ten percent of 
women must drive 100 miles or more for perinatal services.\15\ 
Providers of maternal health care are sparse throughout rural 
areas; nearly half of all counties do not have a single OB-GYN 
or certified nurse midwife.\16\ While telehealth and 
telemedicine have been recognized as methods of providing 
health care in rural areas, its adoption has been limited for 
various reasons, such as limited access to broadband in rural 
areas and cost of equipment or technologies.\17\ These barriers 
to care have been shown to increase rates of maternal 
mortality, SMM, and postpartum depression.\18\
---------------------------------------------------------------------------
    \14\Dina Fine Maron, Maternal Health Care is Disappearing in Rural 
America, Scientific American (https://www.scientificamerican.com/
article/maternal-health-care-is-disappearing-in-rural-america/) (Feb. 
15, 2017).
    \15\Centers for Medicare and Medicaid Services, Improving Access to 
Maternal Health Care in Rural Communities (https://www.cms.gov/About-
CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-
Maternal-Health-Care-in-Rural-Communities.pdf) (June 2019).
    \16\Id.
    \17\Id.
    \18\Id.
---------------------------------------------------------------------------
    Legislation is necessary to authorize Federally-supported 
initiatives that will further improve access to maternal health 
services, develop the maternal health care workforce, continue 
to develop and deploy best practices in maternal health care, 
and establish innovative evidence-informed programs that 
integrate services for pregnant and postpartum women.

Title I--Improving Obstetric Care in Rural Areas

    Title I establishes Rural Obstetric Network Grants to 
improve maternal health care in rural areas. Through these 
grants, care providers in rural areas, frontier areas, 
medically underserved areas, and others, will be able to 
provide greater access to health services, improve training and 
awareness on providing care in rural areas, and allow for 
collaboration between health facilities that have obstetric 
care units and those that do not. This collaboration will 
foster better implementation of best practices to help women at 
risk of maternal mortality and SMM in hospital settings, 
including those facing severe hemorrhage and hypertension. 
Title I also ensures telehealth grants will be available for 
maternal health care and creates a new training demonstration 
grant program to improve and expand training in maternal mental 
health, substance use disorder, social determinants of health, 
and implicit bias for new health care providers in rural areas. 
This title also requires the Government Accountability Office 
(GAO) to report on maternal care in rural areas, including an 
examination of gaps in data on maternal mortality, morbidity 
and maternal health outcomes by race and ethnicity in rural 
communities, with a focus on inequities for residents who are 
racial and ethnic minorities or members of underserved 
populations.

Title II--Other Improvements to Maternal Health

    Title II authorizes the Alliance for Innovation on Maternal 
Health, or AIM Program at the Department of Health and Human 
Services, which works to improve maternal health care standards 
across all settings, through patient safety bundles, grants, 
and other tools for the purposes of: identifying, developing, 
or disseminating best practices to improve maternal health care 
quality and outcomes and eliminate preventable maternal 
mortality and SMM; providing technical assistance to implement 
best practices; and implementing new models of care that 
improve maternal and infant health outcomes. H.R. 4995 
authorizes $10 million in annual appropriations to help expand 
and improve on this program.
    For the purposes of addressing the stark racial disparities 
in maternal health outcomes, title II authorizes $5 million in 
grants to medical and nursing schools, as well as other health 
professional programs, to help reduce and prevent 
discrimination, through training related to implicit and 
explicit biases in providing prenatal care, labor care, 
birthing, and postpartum care. Title II also requires the 
Secretary to enter into a contract with an independent research 
organization to study and make recommendations for medical 
schools, nursing schools, and other health professional 
training programs on best practices related to training to 
reduce and prevent discrimination and implicit and explicit 
biases.
    Title II also supports States' work to improve maternal 
health outcomes by authorizing and expanding grants for 
perinatal quality collaboratives (PQCs) through CDC's National 
Network of Perinatal Quality Collaboratives, which currently 
helps States coordinate to share data and best practices. PQCs 
are State or multi-State networks working to improve the 
quality of care for women and newborns. PQCs may include health 
care providers, hospitals, and public health officials, and may 
focus exclusively on maternal health or neonatal health, or 
both, depending on the needs of the States. State PQCs 
generally develop relationships to improve the collection of 
data and implementation of best practice in the State.
    To further improve care delivery, title II authorizes $15 
million for grants to establish or operate evidence-based or 
innovative, evidence-informed programs to deliver integrated 
health care services to pregnant and postpartum women to 
optimize their health and the health of their infants. To 
receive grants, States, Indian tribes, and tribal organizations 
are required to work with relevant stakeholders to coordinate 
care, including agencies responsible for Medicaid, public 
health, social service, mental health, substance use disorder 
treatment and services, providers of home visiting services, 
and others. These grants may be used to support delivery of 
care to improve health outcomes to States, Indian Tribes, and 
tribal organizations that face the highest rates of maternal 
mortality and SMM, as well as areas where there are health 
disparities associated with racial and ethnic minority 
populations.
    Finally, title II requires the Secretary to produce a 
report no later than February 2026 describing the outcomes of 
activities supported by grants, best practices and models of 
care used by recipients of grants, and any obstacles identified 
by grant recipients. The Secretary will also be required to 
disseminate information on best practices and models of care 
used by recipients of grants to relevant stakeholders, which 
may include health providers, medical schools, nursing schools, 
relevant State, tribal, and local agencies, and the general 
public.

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 4995:
    The Subcommittee on Health held a legislative hearing on 
September 10, 2019, entitled ``Improving Maternal Health: 
Legislation to Advance Prevention Efforts and Access to Care'' 
to review related legislation, including H.R. 1897, the 
``Mothers and Offspring Mortality and Morbidity Awareness 
Act''; H.R. 1551, the ``Quality Care for Moms and Babies Act''; 
H.R. 2902, the ``Maternal Care Access and Reducing Emergencies 
Act''; and H.R. 2602, the ``Healthy MOMMIES Act''. The 
Subcommittee received testimony from the following witnesses:
     Wanda Irving, Mother of Dr. Shalon Irving
     Patrice Harris, M.D., President, Board of 
Trustees, American Medical Association
     Elizabeth Howell, M.D., M.P.P., Director, 
Blavatnik Family Women's Health Research Institute, Icahn 
School of Medicine at Mount Sinai
     David Nelson, M.D., Chief of Obstetrics, Parkland 
Health and Hospital System
     Usha Ranji, Associate Director, Women's Health 
Policy, Kaiser Family Foundation.

                      IV. Committee Consideration

    Representatives Engel (D-NY), Bucshon (R-IN), Torres Small 
(D-MN), Latta (R-OH), Adams (D-NC), and Stivers (R-OH) 
introduced H.R. 4995, the ``Maternal Health Quality Improvement 
Act of 2019'', on November 8, 2019, and the bill was referred 
to the Committee on Energy and Commerce. Subsequently, the bill 
was referred to the Subcommittee on Health on November 12, 
2019.
    On November 13, 2019, the Subcommittee on Health met in 
open markup session, pursuant to notice, to consider H.R. 4995. 
No amendments were offered during consideration of the bill. 
The Subcommittee on Health then agreed to a motion by Ms. 
Eshoo, Chairwoman of the subcommittee, to forward favorably 
H.R. 4995, without amendment, to the full Committee on Energy 
and Commerce by a voice vote.
    On November 19, 2019, the full Committee met in open markup 
session, pursuant to notice, to consider the bill H.R. 4995. 
During consideration of the bill, an amendment offered by Mr. 
Cardenas of California was agreed to by a voice vote. At the 
conclusion of the markup of the bill, Mr. Pallone, Chairman of 
the committee, moved that H.R. 4995 be ordered reported 
favorably to the House, amended. The full Committee agreed to 
the Pallone motion on final passage by a voice vote, a quorum 
being present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
4995, including the motion for final passage of the bill.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.

               VIII. Congressional Budget Office Estimate

                                     U.S. Congress,
                               Congressional Budget Office,
                                 Washington, DC, February 12, 2020.
Hon. Frank Pallone, Jr.,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4995, the Maternal 
Health Quality Improvement Act of 2019.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Philippa 
Haven.
            Sincerely,
                                         Phillip L. Swagel,
                                                          Director.
    Enclosure.

    
    

    H.R. 4995 would require the Health Resources and Services 
Administration or the Centers for Disease Control and 
Prevention to establish five new grant programs and one new 
demonstration program. Specifically:
     Section 102 would establish a new grant program 
for rural obstetric collaborative networks and would authorize 
$3 million each year from 2020 through 2024 to support those 
activities.
     Section 104 would establish a demonstration 
program to improve training for providers of maternal care in 
rural areas and would authorize $5 million each year from 2020 
through 2024 to support those activities.
     Section 201 would establish a competitive grant 
program to identify, develop, or disseminate for best practices 
for improving maternal health care and infant health outcomes 
and would authorize $10 million each year from 2020 through 
2024 to support those activities.
     Section 202 would establish a grant program for 
the training of health professionals to reduce and prevent 
discrimination in the provision of maternal care and would 
authorize $5 million each year from 2020 through 2024 to 
support those activities.
     Section 204 would establish a grant program to 
improve perinatal care and health outcomes and would authorize 
$65 million each year from 2020 through 2024 to support those 
activities. Under current law, $58 million is authorized for 
those activities each year through 2023. As a result, the bill 
would increase authorized amounts by $7 million annually for 
the 2020-2023 period.
     Section 205 would establish a grant program for 
states, Indian tribes, or tribal organizations to establish or 
operate programs that optimize the health of women and their 
infants through integrated care and would authorize $15 million 
each year from 2020 through 2024 to support those activities.
    Based on historical spending for similar programs, CBO 
estimates that, in total, the grant programs would cost $230 
million over the 2020-2025 period.
    In addition, the bill would require two reports. Section 
105 would require the Government Accountability Office to 
publish a report on maternal care in rural areas. Section 203 
would require the Department of Health and Human Services to 
contract with an independent research organization to study and 
recommend best practices for training to reduce and prevent 
discrimination in the provision of prenatal labor, birthing, 
and postpartum care.
    Based on historical spending for similar activates, CBO 
estimates that preparing those two reports would cost about $3 
million over the 2020-2025 period.
    In total and assuming appropriation of the necessary 
amounts, CBO estimates that implementing H.R. 4995 would cost 
$233 million over the 2020-2025 period. The costs of the 
legislation, detailed in Table I, fall within budget function 
550 (health).

               TABLE 1.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 4995
----------------------------------------------------------------------------------------------------------------
                                                              By fiscal year, millions of dollars--
                                                ----------------------------------------------------------------
                                                   2020     2021     2022     2023     2024     2025   2020-2025
----------------------------------------------------------------------------------------------------------------
Estimated Authorization........................       46       46       46       45      103        0       286
Estimated Outlays..............................        *        6       31       56       70       70       233
----------------------------------------------------------------------------------------------------------------
* = between zero and $500,000.

    The CBO staff contacts for this estimate are Alice Burns 
(Health Resources and Services Administration) and Philippa 
Haven (Centers for Disease Control and Prevention, Health and 
Human Services, and National Institutes of Health). The 
estimate was reviewed by Leo Lex, Deputy Director of Budget 
Analysis.

                     IX. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

        X. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to improve 
obstetric care and maternal health outcomes across health care 
settings by increasing resources, improving standards of care, 
and addressing health inequities.

                  XI. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4995 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XII. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

   XIII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 4995 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIV. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

          XVI. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title of this Act may 
be cited as the ``Maternal Health Quality Improvement Act of 
2019''.

Sec. 2. Table of Contents

    Section 2 provides the Table of Contents for H.R. 4995, 
including Title I--Improving Obstetric Care in Rural Areas and 
Title II--Other Improvements to Maternal Care.

            TITLE I--IMPROVING OBSTETRIC CARE IN RURAL AREAS

Sec. 101. Improving rural maternal and obstetric care data

    Section 101, as reported, improves data collection on 
maternal and obstetric care in rural areas across the 
Department of Health and Human Services (HHS), by requiring CDC 
to expand, intensify, and coordinate activities with respect to 
maternal mortality and morbidity; requiring the CDC Office of 
Women's Health to report on women's health across all 
geographic areas and among American Indians and Alaska Natives; 
expanding research activities to improve data collection on 
race, ethnicity, and other demographic information; examining 
the relationship between maternal and obstetric services in 
rural areas and outcomes in delivery and postpartum care; and 
expanding activities within the Office of Research on Women's 
Health at the National Institutes of Health (NIH) to include 
maternal mortality and other maternal morbidity outcomes.

Sec. 102. Rural Obstetric Network Grants

    Section 102 creates Rural Obstetric Network Grants at the 
Health Resources and Services Administration (HRSA) to improve 
birth outcomes and reduce maternal morbidity and mortality by 
improving maternity care and access to care in rural areas, 
frontier areas, maternity care health professional target 
areas, and Indian country, and with Indian Tribes and tribal 
organizations. To do so, the Administrator is authorized to 
award grants to eligible entities to establish collaborative 
improvement and innovation networks. These grants can be used 
to assist pregnant women with accessing and utilizing maternal 
and obstetric care, including preconception, pregnancy, labor 
and delivery, postpartum, and interconception services to 
improve outcomes in birth and maternal mortality and morbidity. 
Grant funds may also be used for the identification of 
successful delivery models for maternal and obstetric care in 
applicable areas, the development of collaborative models 
between health facilities that have an obstetric care unit and 
health facilities that do not have an obstetric care unit, as 
well as for training and guidance on obstetric care for health 
facilities that do not have obstetric care units. Grantees may 
also collaborate with academic institutions for regional 
expertise and research and dedicate funds to measuring and 
addressing inequities in birth outcomes among rural residents, 
with an emphasis on racial and ethnic minorities and 
underserved populations. Section 102 authorizes $3 million 
annually to carry out these activities.

Sec. 103. Telehealth network and telehealth resource centers grant 
        program

    This section adds providers of maternal care to the list of 
eligible entities who may receive telehealth network and 
telehealth resource center grants and ensures applicants who 
provide care for labor and birth and postpartum care are 
prioritized for receiving such grants.

Sec. 104. Rural maternal and obstetric care training demonstration

    Section 104 establishes a training demonstration program to 
award grants to support training for physicians, medical 
residents (including family medicine and obstetrics and 
gynecology residents), fellows, nurse practitioners, physician 
assistants, nurses, certified nurse midwives, home visiting 
nurses, and non-clinical professionals to practice maternal and 
obstetric medicine in rural community-based settings. Those 
receiving grants for these purposes are required to include 
instruction on maternal mental health and substance use 
disorder, social determinants of health that affect individuals 
living in rural communities, and on the reduction of implicit 
bias.
    Section 104 also authorizes grants for medical schools, 
nursing schools, physician assistant education programs, 
accredited public and private nonprofit hospitals, accredited 
medical residency training programs, accredited midwifery 
schools to support establishing, maintaining, or improving 
academic units or programs that provide training for students 
or faculty to improve maternal care in rural areas and develop 
evidence-based practices or recommendations for the design of 
such units or programs.
    Section 104 requires HRSA to submit a report to the House 
Committee on Energy and Commerce and the Senate Committee on 
Health, Education, Labor, and Pensions on the outcomes of the 
demonstration program, including an analysis of the effect of 
the program on the quality, quantity, and distribution of 
maternal health care services, an analysis of maternal and 
infant health outcomes in communities served by entities 
participating in the demonstration program, and recommendations 
on whether the program should be expanded.
    Section 104 authorizes $5 million annually to carry out 
these activities.

Sec. 105. GAO Report

    Section 105 requires the Comptroller General to issue a 
report no later than 18 months after the date of enactment 
identifying potential gaps in maternal and obstetric clinicians 
and health professionals, trends in the number of facilities 
able to provide maternal care, gaps in maternal mortality and 
morbidity data along with recommendations to standardize the 
data collection related to maternal mortality and morbidity, 
gaps in maternal health outcomes by race and ethnicity in rural 
communities, activities which HHS plans to conduct to improve 
maternal care in rural areas, and the extent to which the 
Secretary has a plan for completing these activities, in 
addition to any other information that the Comptroller General 
determines appropriate.

             TITLE II--OTHER IMPROVEMENTS TO MATERNAL CARE

Sec. 201. Innovation for maternal health

    Section 201 requires the Secretary, in consultation with 
experts representing a variety of clinical specialties, State, 
tribal, or local public health officials, researchers, 
epidemiologists, statisticians, and community organizations, to 
establish or continue competitive grants for the purposes of 
identifying, developing, or disseminating best practices to 
improve maternal health care quality and outcomes, eliminating 
preventable maternal mortality and SMM, and facilitating better 
health outcomes. Such best practices may be on improving the 
quality and safety of maternal health care in hospitals and 
other care settings; improving maternal health care based on 
data findings and reviews conducted by a State maternal 
mortality review committee that address topics of relevance to 
common complications or health risks related to prenatal care, 
labor care, birthing, and postpartum care; and addressing 
determinants of health that impact maternal health outcomes. 
Additionally, the grantees may use grant funds to collaborate 
with maternal mortality review committees to identify issues 
that will inform the development and implementation of 
evidence-based practices to improve maternal health outcomes; 
provide technical assistance and support for the implementation 
of evidence-based practices; and identify, develop, and 
evaluate new models of care that improve maternal and infant 
health outcomes, which may include the integration of 
community-based services and clinical care. Section 201 
authorizes $10 million annually to carry out this grant 
program.

Sec. 202. Training for health care providers

    Section 202 requires the Secretary to establish a program 
to award grants to accredited schools of allopathic medicine, 
osteopathic medicine, nursing, and other health professional 
training programs for the purpose of reducing and preventing 
discrimination (including training related to implicit and 
explicit biases) in the provision of health care services 
related to prenatal care, labor care, birthing, and postpartum 
care. Each entity awarded a grant under this program will be 
required to report on activities conducted under the grant, 
including a description of patient outcomes. This section also 
authorizes the Secretary to identify and disseminate best 
practices for the training of health professionals to reduce 
and prevent discrimination. Section 202 authorizes $5 million 
annually to carry out these activities.

Sec. 203. Study on Training To Reduce and Prevent Discrimination

    Section 203 requires the Secretary to contract with an 
independent research organization to conduct a study and make 
recommendations for schools of allopathic medicine, osteopathic 
medicine, nursing, and other health professional training 
programs on best practices for health practitioner training on 
reducing and preventing discrimination, along with implicit and 
explicit biases related to the provision of health services in 
prenatal care, labor care, birthing, and postpartum care.

Sec. 204. Perinatal Quality Collaboratives

    Section 204 amends the Public Health Service Act to require 
the Secretary, acting through the CDC Director, to establish or 
continue grants for PQCs, which are used to improve perinatal 
care and perinatal health outcomes for pregnant or postpartum 
women and their infants. These grants may be used to support 
the identification, development, and dissemination of evidence-
based or evidence-informed best practices to improve outcomes 
for maternal and infant health, and employ strategies or 
provide opportunities for health care professionals and 
clinical teams to collaborate across health care settings and 
disciplines to improve care. Section 204 increases CDC's 
authorization for safe motherhood programs by $7 million 
annually, to $65 million, to fund this grant program.

Sec. 205. Integrated services for pregnant and postpartum women

    Section 205 authorizes the Secretary to award grants to 
establish or operate evidence-based or innovative evidence-
informed programs to deliver integrated health care services to 
pregnant and postpartum women in order to optimize their health 
and the health of their infants. Programs supported by the 
grants would include initiatives that reduce adverse maternal 
health outcomes, pregnancy-related deaths, and related 
disparities, including disparities associated with racial and 
ethnic minority populations. Grantees are required to work with 
stakeholders, including health care providers, relevant 
Medicaid, public health, social services, mental health, and 
substance use disorder treatment and services agencies, and 
community-based health organizations to develop and carry out 
the program. Grants under the program would be awarded for 
five-year periods, and supplemental grants could be made for 
less than five years. In awarding grants, the Secretary is 
required to give preference to states, Tribes, and tribal 
organizations with the highest rates of maternal mortality and 
SMM, giving priority to up to 15 of these applications. The 
Secretary is also required to consider health disparities 
related to maternal mortality and SMM in awarding grants, 
including those disparities associated with racial and ethnic 
minority populations. Section 205 authorizes $15 million 
annually to carry out these activities.
    In addition, Section 205 would require the Secretary to 
submit a report to the House Committee on Energy and Commerce 
and the Senate Committee on Health, Education, Labor, and 
Pensions describing the outcomes of activities supported by the 
grants in this section, along with best practices, models of 
care, and strategies used by grantees to deliver care, improve 
health, and reduce health disparities, and obstacles identified 
by grantees in conducting those activities. Furthermore, 
Section 205 would require the Secretary to disseminate 
information on best practices and models of care to relevant 
stakeholders not later than August 1, 2026.

      XVII. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




           *       *       *       *       *       *       *
     TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE


                   Part A--Research and Investigation


                               in general

  Sec. 301. (a) The Secretary shall conduct in the Service, and 
encourage, cooperate with, and render assistance to other 
appropriate public authorities, scientific institutions, and 
scientists in the conduct of, and promote the coordination of, 
research, investigations, experiments, demonstrations, and 
studies relating to the causes, diagnosis, treatment, control, 
and prevention of physical and mental diseases and impairments 
of man, including water purification, sewage treatment, and 
pollution of lakes and streams. In carrying out the foregoing 
the Secretary is authorized to--
          (1) collect and make available through publications 
        and other appropriate means, information as to, and the 
        practical application of, such research and other 
        activities;
          (2) make available research facilities of the Service 
        to appropriate public authorities, and to health 
        officials and scientists engaged in special study;
          (3) make grants-in-aid to universities, hospitals, 
        laboratories, and other public or private institutions, 
        and to individuals for such research projects as are 
        recommended by the advisory council to the entity of 
        the Department supporting such projects and make, upon 
        recommendation of the advisory council to the 
        appropriate entity of the Department, grants-in-aid to 
        public or nonprofit universities, hospitals, 
        laboratories, and other institutions for the general 
        support of their research;
          (4) secure from time to time and for such periods as 
        he deems advisable, the assistance and advice of 
        experts, scholars, and consultants from the United 
        States or abroad;
          (5) for purposes of study, admit and treat at 
        institutions, hospitals, and stations of the Service, 
        persons not otherwise eligible for such treatment;
          (6) make available, to health officials, scientists, 
        and appropriate public and other nonprofit institutions 
        and organizations, technical advice and assistance on 
        the application of statistical methods to experiments, 
        studies, and surveys in health and medical fields;
          (7) enter into contracts, including contracts for 
        research in accordance with and subject to the 
        provisions of law applicable to contracts entered into 
        by the military departments under title 10, United 
        States Code, sections 2353 and 2354, except that 
        determination, approval, and certification required 
        thereby shall be by the Secretary of Health, Education, 
        and Welfare; and
          (8) adopt, upon recommendations of the advisory 
        councils to the appropriate entities of the Department 
        or, with respect to mental health, the National 
        Advisory Mental Health Council, such additional means 
        as the Secretary considers necessary or appropriate to 
        carry out the purposes of this section.
  (b)(1) The Secretary shall conduct and may support through 
grants and contracts studies and testing of substances for 
carcinogenicity, teratogenicity, mutagenicity, and other 
harmful biological effects. In carrying out this paragraph, the 
Secretary shall consult with entities of the Federal 
Government, outside of the Department of Health, Education, and 
Welfare, engaged in comparable activities. The Secretary, upon 
request of such an entity and under appropriate arrangements 
for the payment of expenses, may conduct for such entity 
studies and testing of substances for carcinogenicity, 
teratogenicity, mutagenicity, and other harmful biological 
effects.
  (2)(A) The Secretary shall establish a comprehensive program 
of research into the biological effects of low-level ionizing 
radiation under which program the Secretary shall conduct such 
research and may support such research by others through grants 
and contracts.
  (B) The Secretary shall conduct a comprehensive review of 
Federal programs of research on the biological effects of 
ionizing radiation.
  (3) The Secretary shall conduct and may support through 
grants and contracts research and studies on human nutrition, 
with particular emphasis on the role of nutrition in the 
prevention and treatment of disease and on the maintenance and 
promotion of health, and programs for the dissemination of 
information respecting human nutrition to health professionals 
and the public. In carrying out activities under this 
paragraph, the Secretary shall provide for the coordination of 
such of these activities as are performed by the different 
divisions within the Department of Health, Education, and 
Welfare and shall consult with entities of the Federal 
Government, outside of the Department of Health, Education, and 
Welfare, engaged in comparable activities. The Secretary, upon 
request of such an entity and under appropriate arrangements 
for the payment of expenses, may conduct and support such 
activities for such entity.
  (4) The Secretary shall publish a biennial report which 
contains--
          (A) a list of all substances (i) which either are 
        known to be carcinogens or may reasonably be 
        anticipated to be carcinogens and (ii) to which a 
        significant number of persons residing in the United 
        States are exposed;
          (B) information concerning the nature of such 
        exposure and the estimated number of persons exposed to 
        such substances;
          (C) a statement identifying (i) each substance 
        contained in the list under subparagraph (A) for which 
        no effluent, ambient, or exposure standard has been 
        established by a Federal agency, and (ii) for each 
        effluent, ambient, or exposure standard established by 
        a Federal agency with respect to a substance contained 
        in the list under subparagraph (A), the extent to 
        which, on the basis of available medical, scientific, 
        or other data, such standard, and the implementation of 
        such standard by the agency, decreases the risk to 
        public health from exposure to the substance; and
          (D) a description of (i) each request received during 
        the year involved--
                  
                  (I) from a Federal agency outside the 
                Department of Health, Education, and Welfare 
                for the Secretary, or
                  (II) from an entity within the Department of 
                Health, Education, and Welfare to any other 
                entity within the Department,
        to conduct research into, or testing for, the 
        carcinogenicity of substances or to provide information 
        described in clause (ii) of subparagraph (C), and (ii) 
        how the Secretary and each such other entity, 
        respectively, have responded to each such request.
  (5) The authority of the Secretary to enter into any contract 
for the conduct of any study, testing, program, research, or 
review, or assessment under this subsection shall be effective 
for any fiscal year only to such extent or in such amounts as 
are provided in advance in Appropriation Acts.
  (c) The Secretary may conduct biomedical research, directly 
or through grants or contracts, for the identification, 
control, treatment, and prevention of diseases (including 
tropical diseases) which do not occur to a significant extent 
in the United States.
  (d)(1)(A) If a person is engaged in biomedical, behavioral, 
clinical, or other research, in which identifiable, sensitive 
information is collected (including research on mental health 
and research on the use and effect of alcohol and other 
psychoactive drugs), the Secretary, in coordination with other 
agencies, as applicable--
          (i) shall issue to such person a certificate of 
        confidentiality to protect the privacy of individuals 
        who are the subjects of such research if the research 
        is funded wholly or in part by the Federal Government; 
        and
          (ii) may, upon application by a person engaged in 
        research, issue to such person a certificate of 
        confidentiality to protect the privacy of such 
        individuals if the research is not so funded.
  (B) Except as provided in subparagraph (C), any person to 
whom a certificate is issued under subparagraph (A) to protect 
the privacy of individuals described in such subparagraph shall 
not disclose or provide to any other person not connected with 
the research the name of such an individual or any information, 
document, or biospecimen that contains identifiable, sensitive 
information about such an individual and that was created or 
compiled for purposes of the research.
  (C) The disclosure prohibition in subparagraph (B) shall not 
apply to disclosure or use that is--
          (i) required by Federal, State, or local laws, 
        excluding instances described in subparagraph (D);
          (ii) necessary for the medical treatment of the 
        individual to whom the information, document, or 
        biospecimen pertains and made with the consent of such 
        individual;
          (iii) made with the consent of the individual to whom 
        the information, document, or biospecimen pertains; or
          (iv) made for the purposes of other scientific 
        research that is in compliance with applicable Federal 
        regulations governing the protection of human subjects 
        in research.
  (D) Any person to whom a certificate is issued under 
subparagraph (A) to protect the privacy of an individual 
described in such subparagraph shall not, in any Federal, 
State, or local civil, criminal, administrative, legislative, 
or other proceeding, disclose or provide the name of such 
individual or any such information, document, or biospecimen 
that contains identifiable, sensitive information about the 
individual and that was created or compiled for purposes of the 
research, except in the circumstance described in subparagraph 
(C)(iii).
  (E) Identifiable, sensitive information protected under 
subparagraph (A), and all copies thereof, shall be immune from 
the legal process, and shall not, without the consent of the 
individual to whom the information pertains, be admissible as 
evidence or used for any purpose in any action, suit, or other 
judicial, legislative, or administrative proceeding.
  (F) Identifiable, sensitive information collected by a person 
to whom a certificate has been issued under subparagraph (A), 
and all copies thereof, shall be subject to the protections 
afforded by this section for perpetuity.
  (G) The Secretary shall take steps to minimize the burden to 
researchers, streamline the process, and reduce the time it 
takes to comply with the requirements of this subsection.
  (2) The Secretary shall coordinate with the heads of other 
applicable Federal agencies to ensure that such departments 
have policies in place with respect to the issuance of a 
certificate of confidentiality pursuant to paragraph (1) and 
other requirements of this subsection.
  (3) Nothing in this subsection shall be construed to limit 
the access of an individual who is a subject of research to 
information about himself or herself collected during such 
individual's participation in the research.
  (4) For purposes of this subsection, the term ``identifiable, 
sensitive information'' means information that is about an 
individual and that is gathered or used during the course of 
research described in paragraph (1)(A) and--
          (A) through which an individual is identified; or
          (B) for which there is at least a very small risk, as 
        determined by current scientific practices or 
        statistical methods, that some combination of the 
        information, a request for the information, and other 
        available data sources could be used to deduce the 
        identity of an individual.
  (e) The Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, shall expand, intensify, 
and coordinate the activities of the Centers for Disease 
Control and Prevention with respect to maternal mortality and 
morbidity.
  [(e)] (f) The Secretary, acting through the Director of the 
Centers for Disease Control and Prevention, shall expand, 
intensify, and coordinate the activities of the Centers for 
Disease Control and Prevention with respect to preterm labor 
and delivery and infant mortality.
  [(f)] (g)(1) The Secretary may exempt from disclosure under 
section 552(b)(3) of title 5, United States Code, biomedical 
information that is about an individual and that is gathered or 
used during the course of biomedical research if--
          (A) an individual is identified; or
          (B) there is at least a very small risk, as 
        determined by current scientific practices or 
        statistical methods, that some combination of the 
        information, the request, and other available data 
        sources could be used to deduce the identity of an 
        individual.
  (2)(A) Each determination of the Secretary under paragraph 
(1) to exempt information from disclosure shall be made in 
writing and accompanied by a statement of the basis for the 
determination.
  (B) Each such determination and statement of basis shall be 
available to the public, upon request, through the Office of 
the Chief FOIA Officer of the Department of Health and Human 
Services.
  (3) Nothing in this subsection shall be construed to limit a 
research participant's access to information about such 
participant collected during the participant's participation in 
the research.
  [(g)] (h) Subchapter I of chapter 35 of title 44, United 
States Code, shall not apply to the voluntary collection of 
information during the conduct of research by the National 
Institutes of Health.
  [(h)] (i)(1) The Secretary may make available to individuals 
and entities, for biomedical and behavioral research, 
substances and living organisms. Such substances and organisms 
shall be made available under such terms and conditions 
(including payment for them) as the Secretary determines 
appropriate.
  (2) Where research substances and living organisms are made 
available under paragraph (1) through contractors, the 
Secretary may direct such contractors to collect payments on 
behalf of the Secretary for the costs incurred to make 
available such substances and organisms and to forward amounts 
so collected to the Secretary, in the time and manner specified 
by the Secretary.
  (3) Amounts collected under paragraph (2) shall be credited 
to the appropriations accounts that incurred the costs to make 
available the research substances and living organisms 
involved, and shall remain available until expended for 
carrying out activities under such accounts.


           *       *       *       *       *       *       *


SEC. 310A. CENTERS FOR DISEASE CONTROL AND PREVENTION OFFICE OF WOMEN'S 
                    HEALTH.

  (a) Establishment.--There is established within the Office of 
the Director of the Centers for Disease Control and Prevention, 
an office to be known as the Office of Women's Health (referred 
to in this section as the ``Office''). The Office shall be 
headed by a director who shall be appointed by the Director of 
such Centers.
  (b) Purpose.--The Director of the Office shall--
          (1) report to the Director of the Centers for Disease 
        Control and Prevention on the current level of the 
        Centers' activity regarding women's health conditions 
        across, where appropriate, age, biological, 
        sociocultural, including among American Indians and 
        Alaska Natives, as such terms are defined in section 4 
        of the Indian Health Care Improvement Act, geographic, 
        and sociocultural contexts, in all aspects of the 
        Centers' work, including prevention programs, public 
        and professional education, services, and treatment;
          (2) establish short-range and long-range goals and 
        objectives within the Centers for women's health and, 
        as relevant and appropriate, coordinate with other 
        appropriate offices on activities within the Centers 
        that relate to prevention, research, education and 
        training, service delivery, and policy development, for 
        issues of particular concern to women;
          (3) identify projects in women's health that should 
        be conducted or supported by the Centers;
          (4) consult with health professionals, 
        nongovernmental organizations, consumer organizations, 
        women's health professionals, and other individuals and 
        groups, as appropriate, on the policy of the Centers 
        with regard to women; and
          (5) serve as a member of the Department of Health and 
        Human Services Coordinating Committee on Women's Health 
        (established under section 229(b)(4)).
  (c) Definition.--As used in this section, the term ``women's 
health conditions'', with respect to women of all age, ethnic, 
and racial groups, means diseases, disorders, and conditions--
          (1) unique to, significantly more serious for, or 
        significantly more prevalent in women; and
          (2) for which the factors of medical risk or type of 
        medical intervention are different for women, or for 
        which there is reasonable evidence that indicates that 
        such factors or types may be different for women.
  (d) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2010 through 2014.

Part B--Federal-State Cooperation

           *       *       *       *       *       *       *



                            safe motherhood

  Sec. 317K. (a) Surveillance.--
          (1) Purpose.--The purposes of this subsection are to 
        establish or continue a Federal initiative to support 
        State and tribal maternal mortality review committees, 
        to improve data collection and reporting around 
        maternal mortality, and to develop or support 
        surveillance systems at the local, State, and national 
        level to better understand the burden of maternal 
        complications and mortality and to decrease the 
        disparities among populations at risk of death and 
        severe complications from pregnancy.
          (2) Activities.--For the purpose described in 
        paragraph (1), the Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, may carry out the following activities:
                  (A) The Secretary may continue and improve 
                activities related to a national maternal 
                mortality data collection and surveillance 
                program to identify and support the review of 
                pregnancy-associated deaths and pregnancy-
                related deaths that occur during, or within 1 
                year following, pregnancy.
                  (B) The Secretary may expand the Pregnancy 
                Risk Assessment Monitoring System to provide 
                surveillance and collect data in each State.
                  (C) The Secretary may expand the Maternal and 
                Child Health Epidemiology Program to provide 
                technical support, financial assistance, or the 
                time-limited assignment of senior 
                epidemiologists to maternal and child health 
                programs in each State.
                  (D) The Secretary may, in cooperation with 
                States, Indian tribes, and tribal 
                organizations, develop a program to support 
                States, Indian tribes, and tribal organizations 
                in establishing or operating maternal mortality 
                review committees, in accordance with 
                subsection (d).
                  (E)(i) The Secretary, acting through the 
                Director of the Centers for Disease Control and 
                Prevention and in coordination with other 
                offices and agencies, as appropriate, shall 
                establish or continue a competitive grant 
                program for the establishment or support of 
                perinatal quality collaboratives to improve 
                perinatal care and perinatal health outcomes 
                for pregnant and postpartum women and their 
                infants. A State, Indian Tribe, or tribal 
                organization may use funds received through 
                such grant to--
                          (I) support the use of evidence-based 
                        or evidence-informed practices to 
                        improve outcomes for maternal and 
                        infant health;
                          (II) work with clinical teams; 
                        experts; State, local, and, as 
                        appropriate, tribal public health 
                        officials; and stakeholders, including 
                        patients and families, to identify, 
                        develop, or disseminate best practices 
                        to improve perinatal care and outcomes; 
                        and
                          (III) employ strategies that provide 
                        opportunities for health care 
                        professionals and clinical teams to 
                        collaborate across health care settings 
                        and disciplines, including primary care 
                        and mental health, as appropriate, to 
                        improve maternal and infant health 
                        outcomes, which may include the use of 
                        data to provide timely feedback across 
                        hospital and clinical teams to inform 
                        responses, and to provide support and 
                        training to hospital and clinical teams 
                        for quality improvement, as 
                        appropriate.
                  (ii) To be eligible for a grant under clause 
                (i), an entity shall submit to the Secretary an 
                application in such form and manner and 
                containing such information as the Secretary 
                may require.
  (b) Prevention Research.--
          (1) Purpose.--The purpose of this subsection is to 
        provide the Secretary with the authority to further 
        expand research concerning risk factors, prevention 
        strategies, and the roles of the family, health care 
        providers and the community in safe motherhood.
          (2) Research.--The Secretary may carry out activities 
        to expand research relating to--
                  (A) prepregnancy counseling, especially for 
                at risk populations such as women with diabetes 
                and women with substance use disorder;
                  (B) the identification of critical components 
                of prenatal delivery and postpartum care;
                  (C) the identification of outreach and 
                support services, such as folic acid education, 
                that are available for pregnant women;
                  (D) the identification of women who are at 
                high risk for complications;
                  (E) preventing preterm delivery;
                  (F) preventing urinary tract infections;
                  (G) preventing unnecessary caesarean 
                sections;
                  (H) the identification of the determinants of 
                disparities in maternal care, health risks, and 
                health outcomes, including an examination of 
                the higher rates of maternal mortality among 
                African American women and other groups of 
                women with disproportionately high rates of 
                maternal mortality;
                  (I) activities to reduce disparities in 
                maternity services and outcomes;
                  (J) an examination of the relationship 
                between interpersonal violence and maternal 
                complications and mortality;
                  (K) preventing and reducing adverse health 
                consequences that may result from smokingand 
                substance abuse and misuse before, during and 
                after pregnancy;
                  (L) preventing infections that cause maternal 
                and infant complications; [and]
                  (M) an examination of the relationship 
                between maternal and obstetric services in 
                rural areas and outcomes in delivery and 
                postpartum care; and
                  [(M)] (N) other areas determined appropriate 
                by the Secretary.
  (c) Prevention Programs.--The Secretary may carry out 
activities to promote safe motherhood, including--
          (1) public education campaigns on healthy 
        pregnancies;
          (2) education programs for physicians, nurses and 
        other health care providers;
          (3) activities to promote community support services 
        for pregnant women; and
          (4) activities to promote physical, mental, and 
        behavioral health during, and up to 1 year following, 
        pregnancy, with an emphasis on prevention of, and 
        treatment for, mental health disorders and substance 
        use disorder.
  (d) Maternal Mortality Review Committees.--
          (1) In general.--In order to participate in the 
        program under subsection (a)(2)(D), the applicable 
        maternal mortality review committee of the State, 
        Indian tribe, or tribal organization shall--
                  (A) include multidisciplinary and diverse 
                membership that represents a variety of 
                clinical specialties, State, tribal, or local 
                public health officials, epidemiologists, 
                statisticians, community organizations, 
                geographic regions within the area covered by 
                such committee, and individuals or 
                organizations that represent the populations in 
                the area covered by such committee that are 
                most affected by pregnancy-related deaths or 
                pregnancy-associated deaths and lack of access 
                to maternal health care services; and
                  (B) demonstrate to the Centers for Disease 
                Control and Prevention that such maternal 
                mortality review committee's methods and 
                processes for data collection and review, as 
                required under paragraph (3), use best 
                practices to reliably determine and include all 
                pregnancy-associated deaths and pregnancy-
                related deaths, regardless of the outcome of 
                the pregnancy.
          (2) Process for confidential reporting.--States, 
        Indian tribes, and tribal organizations that 
        participate in the program described in this subsection 
        shall, through the State maternal mortality review 
        committee, develop a process that--
                  (A) provides for confidential case reporting 
                of pregnancy-associated and pregnancy-related 
                deaths to the appropriate State or tribal 
                health agency, including such reporting by--
                          (i) health care professionals;
                          (ii) health care facilities;
                          (iii) any individual responsible for 
                        completing death records, including 
                        medical examiners and medical coroners; 
                        and
                          (iv) other appropriate individuals or 
                        entities; and
                  (B) provides for voluntary and confidential 
                case reporting of pregnancy-associated deaths 
                and pregnancy-related deaths to the appropriate 
                State or tribal health agency by family members 
                of the deceased, and other appropriate 
                individuals, for purposes of review by the 
                applicable maternal mortality review committee; 
                and
                  (C) shall include--
                          (i) making publicly available contact 
                        information of the committee for use in 
                        such reporting; and
                          (ii) conducting outreach to local 
                        professional organizations, community 
                        organizations, and social services 
                        agencies regarding the availability of 
                        the review committee.
          (3) Data collection and review.--States, Indian 
        tribes, and tribal organizations that participate in 
        the program described in this subsection shall--
                  (A) annually identify pregnancy-associated 
                deaths and pregnancy-related deaths--
                          (i) through the appropriate vital 
                        statistics unit by--
                                  (I) matching each death 
                                record related to a pregnancy-
                                associated death or pregnancy-
                                related death in the State or 
                                tribal area in the applicable 
                                year to a birth certificate of 
                                an infant or fetal death 
                                record, as applicable;
                                  (II) to the extent 
                                practicable, identifying an 
                                underlying or contributing 
                                cause of each pregnancy-
                                associated death and each 
                                pregnancy-related death in the 
                                State or tribal area in the 
                                applicable year; and
                                  (III) collecting data from 
                                medical examiner and coroner 
                                reports, as appropriate;
                          (ii) using other appropriate methods 
                        or information to identify pregnancy-
                        associated deaths and pregnancy-related 
                        deaths, including deaths from pregnancy 
                        outcomes not identified through clause 
                        (i)(I);
                  (B) through the maternal mortality review 
                committee, review data and information to 
                identify adverse outcomes that may contribute 
                to pregnancy-associated death and pregnancy-
                related death, and to identify trends, 
                patterns, and disparities in such adverse 
                outcomes to allow the State, Indian tribe, or 
                tribal organization to make recommendations to 
                individuals and entities described in paragraph 
                (2)(A), as appropriate, to improve maternal 
                care and reduce pregnancy-associated death and 
                pregnancy-related death;
                  (C) identify training available to the 
                individuals and entities described in paragraph 
                (2)(A) for accurate identification and 
                reporting of pregnancy-associated and 
                pregnancy-related deaths;
                  (D) ensure that, to the extent practicable, 
                the data collected and reported under this 
                paragraph is in a format that allows for 
                analysis by the Centers for Disease Control and 
                Prevention; and
                  (E) publicly identify the methods used to 
                identify pregnancy-associated deaths and 
                pregnancy-related deaths in accordance with 
                this section.
          (4) Confidentiality.--States, Indian tribes, and 
        tribal organizations participating in the program 
        described in this subsection shall establish 
        confidentiality protections to ensure, at a minimum, 
        that--
                  (A) there is no disclosure by the maternal 
                mortality review committee, including any 
                individual members of the committee, to any 
                person, including any government official, of 
                any identifying information about any specific 
                maternal mortality case; and
                  (B) no information from committee 
                proceedings, including deliberation or records, 
                is made public unless specifically authorized 
                under State and Federal law.
          (5) Reports to cdc.--For fiscal year 2019, and each 
        subsequent fiscal year, each maternal mortality review 
        committee participating in the program described in 
        this subsection shall submit to the Director of the 
        Centers for Disease Control and Prevention a report 
        that includes--
                  (A) data, findings, and any recommendations 
                of such committee; and
                  (B) as applicable, information on the 
                implementation during such year of any 
                recommendations submitted by the committee in a 
                previous year.
          (6) State partnerships.--States may partner with one 
        or more neighboring States to carry out the activities 
        under this subparagraph. With respect to the States in 
        such a partnership, any requirement under this 
        subparagraph relating to the reporting of information 
        related to such activities shall be deemed to be 
        fulfilled by each such State if a single such report is 
        submitted for the partnership.
          (7) Appropriate mechanisms for indian tribes and 
        tribal organizations.--The Secretary, in consultation 
        with Indian tribes, shall identify and establish 
        appropriate mechanisms for Indian tribes and tribal 
        organizations to demonstrate, report data, and conduct 
        the activities as required for participation in the 
        program described in this subsection. Such mechanisms 
        may include technical assistance with respect to grant 
        application and submission procedures, and award 
        management activities.
          (8) Research availability.--The Secretary shall 
        develop a process to ensure that data collected under 
        paragraph (5) is made available, as appropriate and 
        practicable, for research purposes, in a manner that 
        protects individually identifiable or potentially 
        identifiable information and that is consistent with 
        State and Federal privacy law.
  (e) Definitions.--In this section--
          (1) the terms ``Indian tribe'' and ``tribal 
        organization'' have the meanings given such terms in 
        section 4 of the Indian Self-Determination and 
        Education Assistance Act;
          (2) the term ``pregnancy-associated death'' means a 
        death of a woman, by any cause, that occurs during, or 
        within 1 year following, her pregnancy, regardless of 
        the outcome, duration, or site of the pregnancy; and
          (3) the term ``pregnancy-related death'' means a 
        death of a woman that occurs during, or within 1 year 
        following, her pregnancy, regardless of the outcome, 
        duration, or site of the pregnancy--
                  (A) from any cause related to, or aggravated 
                by, the pregnancy or its management; and
                  (B) not from accidental or incidental causes.
  (f) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated [$58,000,000 for each of fiscal years 2019 through 
2023] $65,000,000 for each of fiscal years 2020 through 2024.

           *       *       *       *       *       *       *


                      Part D--Primary Health Care


Subpart I--Health Centers

           *       *       *       *       *       *       *



SEC. 330A-2. RURAL OBSTETRIC NETWORK GRANTS.

  (a) Program Established.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, shall award grants to eligible entities to 
establish collaborative improvement and innovation networks 
(referred to in this section as ``rural obstetric networks'') 
to improve birth outcomes and reduce maternal morbidity and 
mortality by improving maternity care and access to care in 
rural areas, frontier areas, maternity care health professional 
target areas, and Indian country and with Indian Tribes and 
tribal organizations.
  (b) Use of Funds.--Rural obstetric networks receiving funds 
pursuant to this section may use such funds to--
          (1) assist pregnant women and individuals in areas 
        and within populations referenced in subsection (a) 
        with accessing and utilizing maternal and obstetric 
        care, including preconception, pregnancy, labor and 
        delivery, postpartum, and interconception services to 
        improve outcomes in birth and maternal mortality and 
        morbidity;
          (2) identify successful delivery models for maternal 
        and obstetric care (including preconception, pregnancy, 
        labor and delivery, postpartum, and interconception 
        services) for individuals in areas and within 
        populations referenced by subsection (a), including 
        evidence-based home visiting programs and successful, 
        culturally competent models with positive maternal 
        health outcomes that advance health equity;
          (3) develop a model for collaboration between health 
        facilities that have an obstetric care unit and health 
        facilities that do not have an obstetric care unit to 
        improve access to and the delivery of obstetric 
        services in communities lacking these services;
          (4) provide training and guidance on obstetric care 
        for health facilities that do not have obstetric care 
        units;
          (5) collaborate with academic institutions that can 
        provide regional expertise and research on access, 
        outcomes, needs assessments, and other identified data 
        and measurement activities needed to inform rural 
        obstetric network efforts to improve obstetric care; 
        and
          (6) measure and address inequities in birth outcomes 
        among rural residents, with an emphasis on racial and 
        ethnic minorities and underserved populations.
  (c) Definitions.--In this section:
          (1) Eligible entities.--The term ``eligible 
        entities'' means entities providing obstetric, 
        gynecologic, and other maternal health care services in 
        rural areas, frontier areas, or medically underserved 
        areas, or to medically underserved populations or 
        Native Americans, including Indian tribes or tribal 
        organizations.
          (2) Frontier area.--The term ``frontier area'' means 
        a frontier county, as defined in section 
        1886(d)(3)(E)(iii)(III) of the Social Security Act.
          (3) Indian country.--The term ``Indian country'' has 
        the meaning given such term in section 1151 of title 
        18, United States Code.
          (4) Maternity care health professional target area.--
        The term ``maternity care health professional target 
        area'' has the meaning of such term as used in section 
        332(k)(2).
          (5) Rural area.--The term ``rural area'' has the 
        meaning given that term in section 1886(d)(2) of the 
        Social Security Act.
          (6) Indian tribes; tribal organization.--The terms 
        ``Indian Tribe'' and ``tribal organization'' have the 
        meaning given such terms in section 4 of the Indian 
        Self-Determination and Education Assistance Act.
  (d) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section $3,000,000 for each 
of fiscal years 2020 through 2024.

           *       *       *       *       *       *       *


SEC. 330I. TELEHEALTH NETWORK AND TELEHEALTH RESOURCE CENTERS GRANT 
                    PROGRAMS.

  (a) Definitions.--In this section:
          (1) Director; office.--The terms ``Director'' and 
        ``Office'' mean the Director and Office specified in 
        subsection (c).
          (2) Federally qualified health center and rural 
        health clinic.--The term ``Federally qualified health 
        center'' and ``rural health clinic'' have the meanings 
        given the terms in section 1861(aa) of the Social 
        Security Act (42 U.S.C. 1395x(aa)).
          (3) Frontier community.--The term ``frontier 
        community'' shall have the meaning given the term in 
        regulations issued under subsection (r).
          (4) Medically underserved area.--The term ``medically 
        underserved area'' has the meaning given the term 
        ``medically underserved community'' in section 799B(6).
          (5) Medically underserved population.--The term 
        ``medically underserved population'' has the meaning 
        given the term in section 330(b)(3).
          (6) Telehealth services.--The term ``telehealth 
        services'' means services provided through telehealth 
        technologies.
          (7) Telehealth technologies.--The term ``telehealth 
        technologies'' means technologies relating to the use 
        of electronic information, and telecommunications 
        technologies, to support and promote, at a distance, 
        health care, patient and professional health-related 
        education, health administration, and public health.
  (b) Programs.--The Secretary shall establish, under section 
301, telehealth network and telehealth resource centers grant 
programs.
  (c) Administration.--
          (1) Establishment.--There is established in the 
        Health Resources and Services Administration an Office 
        for the Advancement of Telehealth. The Office shall be 
        headed by a Director.
          (2) Duties.--The telehealth network and telehealth 
        resource centers grant programs established under 
        section 301 shall be administered by the Director, in 
        consultation with the State offices of rural health, 
        State offices concerning primary care, or other 
        appropriate State government entities.
  (d) Grants.--
          (1) Telehealth network grants.--The Director may, in 
        carrying out the telehealth network grant program 
        referred to in subsection (b), award grants to eligible 
        entities for projects to demonstrate how telehealth 
        technologies can be used through telehealth networks in 
        rural areas, frontier communities, and medically 
        underserved areas, and for medically underserved 
        populations, to--
                  (A) expand access to, coordinate, and improve 
                the quality of health care services;
                  (B) improve and expand the training of health 
                care providers; and
                  (C) expand and improve the quality of health 
                information available to health care providers, 
                and patients and their families, for 
                decisionmaking.
          (2) Telehealth resource centers grants.--The Director 
        may, in carrying out the telehealth resource centers 
        grant program referred to in subsection (b), award 
        grants to eligible entities for projects to demonstrate 
        how telehealth technologies can be used in the areas 
        and communities, and for the populations, described in 
        paragraph (1), to establish telehealth resource 
        centers.
  (e) Grant Periods.--The Director may award grants under this 
section for periods of not more than 4 years.
  (f) Eligible Entities.--
          (1) Telehealth network grants.--
                  (A) Grant recipient.--To be eligible to 
                receive a grant under subsection (d)(1), an 
                entity shall be a nonprofit entity.
                  (B) Telehealth networks.--
                          (i) In general.--To be eligible to 
                        receive a grant under subsection 
                        (d)(1), an entity shall demonstrate 
                        that the entity will provide services 
                        through a telehealth network.
                          (ii) Nature of entities.--Each entity 
                        participating in the telehealth network 
                        may be a nonprofit or for-profit 
                        entity.
                          (iii) Composition of network.--The 
                        telehealth network shall include at 
                        least 2 of the following entities (at 
                        least 1 of which shall be a community-
                        based health care provider):
                                  (I) Community or migrant 
                                health centers or other 
                                Federally qualified health 
                                centers.
                                  (II) Health care providers, 
                                including pharmacists, in 
                                private practice.
                                  (III) Entities operating 
                                clinics, including rural health 
                                clinics.
                                  (IV) Local health 
                                departments.
                                  (V) Nonprofit hospitals, 
                                including community access 
                                hospitals.
                                  (VI) Other publicly funded 
                                health or social service 
                                agencies.
                                  (VII) Long-term care 
                                providers.
                                  (VIII) Providers of health 
                                care services in the home.
                                  (IX) Providers of outpatient 
                                mental health services and 
                                entities operating outpatient 
                                mental health facilities.
                                  (X) Local or regional 
                                emergency health care 
                                providers.
                                  (XI) Institutions of higher 
                                education.
                                  (XII) Entities operating 
                                dental clinics.
                                  (XIII) Providers of maternal, 
                                including prenatal, labor and 
                                birth, and postpartum care 
                                services and entities operating 
                                obstetric care units.
          (2) Telehealth resource centers grants.--To be 
        eligible to receive a grant under subsection (d)(2), an 
        entity shall be a nonprofit entity.
  (g) Applications.--To be eligible to receive a grant under 
subsection (d), an eligible entity, in consultation with the 
appropriate State office of rural health or another appropriate 
State entity, shall prepare and submit to the Secretary an 
application, at such time, in such manner, and containing such 
information as the Secretary may require, including--
          (1) a description of the project that the eligible 
        entity will carry out using the funds provided under 
        the grant;
          (2) a description of the manner in which the project 
        funded under the grant will meet the health care needs 
        of rural or other populations to be served through the 
        project, or improve the access to services of, and the 
        quality of the services received by, those populations;
          (3) evidence of local support for the project, and a 
        description of how the areas, communities, or 
        populations to be served will be involved in the 
        development and ongoing operations of the project;
          (4) a plan for sustaining the project after Federal 
        support for the project has ended;
          (5) information on the source and amount of non-
        Federal funds that the entity will provide for the 
        project;
          (6) information demonstrating the long-term viability 
        of the project, and other evidence of institutional 
        commitment of the entity to the project;
          (7) in the case of an application for a project 
        involving a telehealth network, information 
        demonstrating how the project will promote the 
        integration of telehealth technologies into the 
        operations of health care providers, to avoid 
        redundancy, and improve access to and the quality of 
        care; and
          (8) other such information as the Secretary 
        determines to be appropriate.
  (h) Terms; Conditions; Maximum Amount of Assistance.--The 
Secretary shall establish the terms and conditions of each 
grant program described in subsection (b) and the maximum 
amount of a grant to be awarded to an individual recipient for 
each fiscal year under this section. The Secretary shall 
publish, in a publication of the Health Resources and Services 
Administration, notice of the application requirements for each 
grant program described in subsection (b) for each fiscal year.
  (i) Preferences.--
          (1) Telehealth networks.--In awarding grants under 
        subsection (d)(1) for projects involving telehealth 
        networks, the Secretary shall give preference to an 
        eligible entity that meets at least 1 of the following 
        requirements:
                  (A) Organization.--The eligible entity is a 
                rural community-based organization or another 
                community-based organization.
                  (B) Services.--The eligible entity proposes 
                to use Federal funds made available through 
                such a grant to develop plans for, or to 
                establish, telehealth networks that provide 
                mental health, public health, long-term care, 
                home care, preventive, case management 
                services, labor and birth, postpartum, or 
                prenatal care for high-risk pregnancies.
                  (C) Coordination.--The eligible entity 
                demonstrates how the project to be carried out 
                under the grant will be coordinated with other 
                relevant federally funded projects in the 
                areas, communities, and populations to be 
                served through the grant.
                  (D) Network.--The eligible entity 
                demonstrates that the project involves a 
                telehealth network that includes an entity 
                that--
                          (i) provides clinical health care 
                        services, or educational services for 
                        health care providers and for patients 
                        or their families; and
                          (ii) is--
                                  (I) a public library;
                                  (II) an institution of higher 
                                education; or
                                  (III) a local government 
                                entity.
                  (E) Connectivity.--The eligible entity 
                proposes a project that promotes local 
                connectivity within areas, communities, or 
                populations to be served through the project.
                  (F) Integration.--The eligible entity 
                demonstrates that health care information has 
                been integrated into the project.
          (2) Telehealth resource centers.--In awarding grants 
        under subsection (d)(2) for projects involving 
        telehealth resource centers, the Secretary shall give 
        preference to an eligible entity that meets at least 1 
        of the following requirements:
                  (A) Provision of services.--The eligible 
                entity has a record of success in the provision 
                of telehealth services to medically underserved 
                areas or medically underserved populations.
                  (B) Collaboration and sharing of expertise.--
                The eligible entity has a demonstrated record 
                of collaborating and sharing expertise with 
                providers of telehealth services at the 
                national, regional, State, and local levels.
                  (C) Broad range of telehealth services.--The 
                eligible entity has a record of providing a 
                broad range of telehealth services, which may 
                include--
                          (i) a variety of clinical specialty 
                        services;
                          (ii) patient or family education;
                          (iii) health care professional 
                        education; and
                          (iv) rural residency support 
                        programs.
  (j) Distribution of Funds.--
          (1) In general.--In awarding grants under this 
        section, the Director shall ensure, to the greatest 
        extent possible, that such grants are equitably 
        distributed among the geographical regions of the 
        United States.
          (2) Telehealth networks.--In awarding grants under 
        subsection (d)(1) for a fiscal year, the Director shall 
        ensure that--
                  (A) not less than 50 percent of the funds 
                awarded shall be awarded for projects in rural 
                areas; and
                  (B) the total amount of funds awarded for 
                such projects for that fiscal year shall be not 
                less than the total amount of funds awarded for 
                such projects for fiscal year 2001 under 
                section 330A (as in effect on the day before 
                the date of enactment of the Health Care Safety 
                Net Amendments of 2002).
  (k) Use of Funds.--
          (1) Telehealth network program.--The recipient of a 
        grant under subsection (d)(1) may use funds received 
        through such grant for salaries, equipment, and 
        operating or other costs, including the cost of--
                  (A) developing and delivering clinical 
                telehealth services that enhance access to 
                community-based health care services in rural 
                areas, frontier communities, or medically 
                underserved areas, or for medically underserved 
                populations;
                  (B) developing and acquiring, through lease 
                or purchase, computer hardware and software, 
                audio and video equipment, computer network 
                equipment, interactive equipment, data terminal 
                equipment, and other equipment that furthers 
                the objectives of the telehealth network grant 
                program;
                  (C)(i) developing and providing distance 
                education, in a manner that enhances access to 
                care in rural areas, frontier communities, or 
                medically underserved areas, or for medically 
                underserved populations; or
                  (ii) mentoring, precepting, or supervising 
                health care providers and students seeking to 
                become health care providers, in a manner that 
                enhances access to care in the areas and 
                communities, or for the populations, described 
                in clause (i);
                  (D) developing and acquiring instructional 
                programming;
                  (E)(i) providing for transmission of medical 
                data, and maintenance of equipment; and
                  (ii) providing for compensation (including 
                travel expenses) of specialists, and referring 
                health care providers, who are providing 
                telehealth services through the telehealth 
                network, if no third party payment is available 
                for the telehealth services delivered through 
                the telehealth network;
                  (F) developing projects to use telehealth 
                technology to facilitate collaboration between 
                health care providers;
                  (G) collecting and analyzing usage statistics 
                and data to document the cost-effectiveness of 
                the telehealth services; and
                  (H) carrying out such other activities as are 
                consistent with achieving the objectives of 
                this section, as determined by the Secretary.
          (2) Telehealth resource centers.--The recipient of a 
        grant under subsection (d)(2) may use funds received 
        through such grant for salaries, equipment, and 
        operating or other costs for--
                  (A) providing technical assistance, training, 
                and support, and providing for travel expenses, 
                for health care providers and a range of health 
                care entities that provide or will provide 
                telehealth services;
                  (B) disseminating information and research 
                findings related to telehealth services;
                  (C) promoting effective collaboration among 
                telehealth resource centers and the Office;
                  (D) conducting evaluations to determine the 
                best utilization of telehealth technologies to 
                meet health care needs;
                  (E) promoting the integration of the 
                technologies used in clinical information 
                systems with other telehealth technologies;
                  (F) fostering the use of telehealth 
                technologies to provide health care information 
                and education for health care providers and 
                consumers in a more effective manner; and
                  (G) implementing special projects or studies 
                under the direction of the Office.
  (l) Prohibited Uses of Funds.--An entity that receives a 
grant under this section may not use funds made available 
through the grant--
          (1) to acquire real property;
          (2) for expenditures to purchase or lease equipment, 
        to the extent that the expenditures would exceed 40 
        percent of the total grant funds;
          (3) in the case of a project involving a telehealth 
        network, to purchase or install transmission equipment 
        (such as laying cable or telephone lines, or purchasing 
        or installing microwave towers, satellite dishes, 
        amplifiers, or digital switching equipment);
          (4) to pay for any equipment or transmission costs 
        not directly related to the purposes for which the 
        grant is awarded;
          (5) to purchase or install general purpose voice 
        telephone systems;
          (6) for construction; or
          (7) for expenditures for indirect costs (as 
        determined by the Secretary), to the extent that the 
        expenditures would exceed 15 percent of the total grant 
        funds.
  (m) Collaboration.--In providing services under this section, 
an eligible entity shall collaborate, if feasible, with 
entities that--
          (1)(A) are private or public organizations, that 
        receive Federal or State assistance; or
          (B) are public or private entities that operate 
        centers, or carry out programs, that receive Federal or 
        State assistance; and
          (2) provide telehealth services or related 
        activities.
  (n) Coordination With Other Agencies.--The Secretary shall 
coordinate activities carried out under grant programs 
described in subsection (b), to the extent practicable, with 
Federal and State agencies and nonprofit organizations that are 
operating similar programs, to maximize the effect of public 
dollars in funding meritorious proposals.
  (o) Outreach Activities.--The Secretary shall establish and 
implement procedures to carry out outreach activities to advise 
potential end users of telehealth services in rural areas, 
frontier communities, medically underserved areas, and 
medically underserved populations in each State about the grant 
programs described in subsection (b).
  (p) Telehealth.--It is the sense of Congress that, for 
purposes of this section, States should develop reciprocity 
agreements so that a provider of services under this section 
who is a licensed or otherwise authorized health care provider 
under the law of 1 or more States, and who, through telehealth 
technology, consults with a licensed or otherwise authorized 
health care provider in another State, is exempt, with respect 
to such consultation, from any State law of the other State 
that prohibits such consultation on the basis that the first 
health care provider is not a licensed or authorized health 
care provider under the law of that State.
  (q) Report.--Not later than September 30, 2005, the Secretary 
shall prepare and submit to the appropriate committees of 
Congress a report on the progress and accomplishments of the 
grant programs described in subsection (b).
  (r) Regulations.--The Secretary shall issue regulations 
specifying, for purposes of this section, a definition of the 
term ``frontier area''. The definition shall be based on 
factors that include population density, travel distance in 
miles to the nearest medical facility, travel time in minutes 
to the nearest medical facility, and such other factors as the 
Secretary determines to be appropriate. The Secretary shall 
develop the definition in consultation with the Director of the 
Bureau of the Census and the Administrator of the Economic 
Research Service of the Department of Agriculture.
  (s) Authorization of Appropriations.--There are authorized to 
be appropriated to carry out this section--
          (1) for grants under subsection (d)(1), $40,000,000 
        for fiscal year 2002, and such sums as may be necessary 
        for each of fiscal years 2003 through 2006; and
          (2) for grants under subsection (d)(2), $20,000,000 
        for fiscal year 2002, and such sums as may be necessary 
        for each of fiscal years 2003 through 2006.

           *       *       *       *       *       *       *


SEC. 330M. PEDIATRIC MENTAL HEALTH CARE ACCESS GRANTS.

  (a) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration and in coordination with other relevant Federal 
agencies, shall award grants to States, political subdivisions 
of States, and Indian tribes and tribal organizations (for 
purposes of this section, as such terms are defined in section 
4 of the Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450b)) to promote behavioral health integration in 
pediatric primary care by--
          (1) supporting the development of statewide or 
        regional pediatric mental health care telehealth access 
        programs; and
          (2) supporting the improvement of existing statewide 
        or regional pediatric mental health care telehealth 
        access programs.
  (b) Program Requirements.--
          (1) In general.--A pediatric mental health care 
        telehealth access program referred to in subsection 
        (a), with respect to which a grant under such 
        subsection may be used, shall--
                  (A) be a statewide or regional network of 
                pediatric mental health teams that provide 
                support to pediatric primary care sites as an 
                integrated team;
                  (B) support and further develop organized 
                State or regional networks of pediatric mental 
                health teams to provide consultative support to 
                pediatric primary care sites;
                  (C) conduct an assessment of critical 
                behavioral consultation needs among pediatric 
                providers and such providers' preferred 
                mechanisms for receiving consultation, 
                training, and technical assistance;
                  (D) develop an online database and 
                communication mechanisms, including telehealth, 
                to facilitate consultation support to pediatric 
                practices;
                  (E) provide rapid statewide or regional 
                clinical telephone or telehealth consultations 
                when requested between the pediatric mental 
                health teams and pediatric primary care 
                providers;
                  (F) conduct training and provide technical 
                assistance to pediatric primary care providers 
                to support the early identification, diagnosis, 
                treatment, and referral of children with 
                behavioral health conditions;
                  (G) provide information to pediatric 
                providers about, and assist pediatric providers 
                in accessing, pediatric mental health care 
                providers, including child and adolescent 
                psychiatrists, and licensed mental health 
                professionals, such as psychologists, social 
                workers, or mental health counselors and in 
                scheduling and conducting technical assistance;
                  (H) assist with referrals to specialty care 
                and community or behavioral health resources; 
                and
                  (I) establish mechanisms for measuring and 
                monitoring increased access to pediatric mental 
                health care services by pediatric primary care 
                providers and expanded capacity of pediatric 
                primary care providers to identify, treat, and 
                refer children with mental health problems.
          (2) Pediatric mental health teams.--In this 
        subsection, the term ``pediatric mental health team'' 
        means a team consisting of at least one case 
        coordinator, at least one child and adolescent 
        psychiatrist, and at least one licensed clinical mental 
        health professional, such as a psychologist, social 
        worker, or mental health counselor. Such a team may be 
        regionally based.
  (c) Application.--A State, political subdivision of a State, 
Indian tribe, or tribal organization seeking a grant under this 
section shall submit an application to the Secretary at such 
time, in such manner, and containing such information as the 
Secretary may require, including a plan for the comprehensive 
evaluation of activities that are carried out with funds 
received under such grant.
  (d) Evaluation.--A State, political subdivision of a State, 
Indian tribe, or tribal organization that receives a grant 
under this section shall prepare and submit an evaluation of 
activities that are carried out with funds received under such 
grant to the Secretary at such time, in such manner, and 
containing such information as the Secretary may reasonably 
require, including a process and outcome evaluation.
  (e) Access to Broadband.--In administering grants under this 
section, the Secretary may coordinate with other agencies to 
ensure that funding opportunities are available to support 
access to reliable, high-speed Internet for providers.
  (f) Matching Requirement.--The Secretary may not award a 
grant under this section unless the State, political 
subdivision of a State, Indian tribe, or tribal organization 
involved agrees, with respect to the costs to be incurred by 
the State, political subdivision of a State, Indian tribe, or 
tribal organization in carrying out the purpose described in 
this section, to make available non-Federal contributions (in 
cash or in kind) toward such costs in an amount that is not 
less than 20 percent of Federal funds provided in the grant.
  (g) Authorization of Appropriations.--To carry out this 
section, there are authorized to be appropriated, $9,000,000 
for the period of fiscal years 2018 through 2022.

SEC. 330N. INNOVATION FOR MATERNAL HEALTH.

  (a) In General.--The Secretary, in consultation with experts 
representing a variety of clinical specialties, State, tribal, 
or local public health officials, researchers, epidemiologists, 
statisticians, and community organizations, shall establish or 
continue a program to award competitive grants to eligible 
entities for the purpose of--
          (1) identifying, developing, or disseminating best 
        practices to improve maternal health care quality and 
        outcomes, eliminate preventable maternal mortality and 
        severe maternal morbidity, and improve infant health 
        outcomes, which may include--
                  (A) information on evidence-based practices 
                to improve the quality and safety of maternal 
                health care in hospitals and other health care 
                settings of a State or health care system, 
                including by addressing topics commonly 
                associated with health complications or risks 
                related to prenatal care, labor care, birthing, 
                and postpartum care;
                  (B) best practices for improving maternal 
                health care based on data findings and reviews 
                conducted by a State maternal mortality review 
                committee that address topics of relevance to 
                common complications or health risks related to 
                prenatal care, labor care, birthing, and post-
                partum care; and
                  (C) information on addressing determinants of 
                health that impact maternal health outcomes for 
                women before, during, and after pregnancy;
          (2) collaborating with State maternal mortality 
        review committees to identify issues for the 
        development and implementation of evidence-based 
        practices to improve maternal health outcomes and 
        reduce preventable maternal mortality and severe 
        maternal morbidity;
          (3) providing technical assistance and supporting the 
        implementation of best practices identified in 
        paragraph (1) to entities providing health care 
        services to pregnant and postpartum women; and
          (4) identifying, developing, and evaluating new 
        models of care that improve maternal and infant health 
        outcomes, which may include the integration of 
        community-based services and clinical care.
  (b) Eligible Entities.--To be eligible for a grant under 
subsection (a), an entity shall--
          (1) submit to the Secretary an application at such 
        time, in such manner, and containing such information 
        as the Secretary may require; and
          (2) demonstrate in such application that the entity 
        is capable of carrying out data-driven maternal safety 
        and quality improvement initiatives in the areas of 
        obstetrics and gynecology or maternal health.
  (c) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated $10,000,000 for 
each of fiscal years 2020 through 2024.

SEC. 330O. INTEGRATED SERVICES FOR PREGNANT AND POSTPARTUM WOMEN.

  (a) In General.--The Secretary may award grants for the 
purpose of establishing or operating evidence-based or 
innovative, evidence-informed programs to deliver integrated 
health care services to pregnant and postpartum women to 
optimize the health of women and their infants, including--
          (1) to reduce adverse maternal health outcomes, 
        pregnancy-related deaths, and related health 
        disparities (including such disparities associated with 
        racial and ethnic minority populations); and
          (2) as appropriate, by addressing issues researched 
        under section 317K(b)(2).
  (b) Integrated Services for Pregnant and Postpartum Women.--
          (1) Eligibility To be eligible to receive a grant 
        under subsection (a), a State, Indian Tribe, or tribal 
        organization (as such terms are defined in section 4 of 
        the Indian Self-Determination and Education Assistance 
        Act) shall work with relevant stakeholders that 
        coordinate care (including coordinating resources and 
        referrals for health care and social services) to 
        develop and carry out the program, including--
                  (A) State, Tribal, and local agencies 
                responsible for Medicaid, public health, social 
                services, mental health, and substance use 
                disorder treatment and services;
                  (B) health care providers who serve pregnant 
                and postpartum women; and
                  (C) community-based health organizations and 
                health workers, including providers of home 
                visiting services and individuals representing 
                communities with disproportionately high rates 
                of maternal mortality and severe maternal 
                morbidity, and including those representing 
                racial and ethnicity minority populations.
          (2) Terms
                  (A) Period A grant awarded under subsection 
                (a) shall be made for a period of 5 years. Any 
                supplemental award made to a grantee under 
                subsection (a) may be made for a period of less 
                than 5 years.
                  (B) Preference In awarding grants under 
                subsection (a), the Secretary shall--
                          (i) give preference to States, Indian 
                        Tribes, and tribal organizations that 
                        have the highest rates of maternal 
                        mortality and severe maternal morbidity 
                        relative to other such States, Indian 
                        Tribes, or tribal organizations, 
                        respectively; and
                          (ii) shall consider health 
                        disparities related to maternal 
                        mortality and severe maternal 
                        morbidity, including such disparities 
                        associated with racial and ethnic 
                        minority populations.
                  (C) Priority In awarding grants under 
                subsection (a), the Secretary shall give 
                priority to applications from up to 15 entities 
                described in subparagraph (B)(i).
                  (D) Evaluation The Secretary shall require 
                grantees to evaluate the outcomes of the 
                programs supported under the grant.
  (c) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated $15,000,000 for 
each of fiscal years 2020 through 2024.

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TITLE IV--NATIONAL RESEARCH INSTITUTES

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                   Part F--Research on Women's Health


SEC. 486. OFFICE OF RESEARCH ON WOMEN'S HEALTH.

  (a) Establishment.--There is established within the Office of 
the Director of NIH an office to be known as the Office of 
Research on Women's Health (in this part referred to as the 
``Office''). The Office shall be headed by a director, who 
shall be appointed by the Director of NIH and who shall report 
directly to the Director.
  (b) Purpose.--The Director of the Office shall--
          (1) identify projects of research on women's health 
        that should be conducted or supported by the national 
        research institutes;
          (2) identify multidisciplinary research relating to 
        research on women's health that should be so conducted 
        or supported;
          [(3) carry out paragraphs (1) and (2) with respect to 
        the aging process in women, with priority given to 
        menopause;]
          (3) carry out paragraphs (1) and (2) with respect 
        to--
                  (A) the aging process in women, with priority 
                given to menopause; and
                  (B) pregnancy, with priority given to deaths 
                related to pregnancy;
          (4) promote coordination and collaboration among 
        entities conducting research identified under any of 
        paragraphs (1) through (3);
          (5) encourage the conduct of such research by 
        entities receiving funds from the national research 
        institutes;
          (6) recommend an agenda for conducting and supporting 
        such research;
          (7) promote the sufficient allocation of the 
        resources of the national research institutes for 
        conducting and supporting such research;
          (8) assist in the administration of section 492B with 
        respect to the inclusion of women as subjects in 
        clinical research; and
          (9) prepare the report required in section 486B.
  (c) Coordinating Committee.--
          (1) In carrying out subsection (b), the Director of 
        the Office shall establish a committee to be known as 
        the Coordinating Committee on Research on Women's 
        Health (in this subsection referred to as the 
        ``Coordinating Committee'').
          (2) The Coordinating Committee shall be composed of 
        the Directors of the national research institutes (or 
        the senior-level staff designees of the Directors).
          (3) The Director of the Office shall serve as the 
        chair of the Coordinating Committee.
          (4) With respect to research on women's health, the 
        Coordinating Committee shall assist the Director of the 
        Office in--
                  (A) identifying the need for such research, 
                and making an estimate each fiscal year of the 
                funds needed to adequately support the 
                research;
                  (B) identifying needs regarding the 
                coordination of research activities, including 
                intramural and extramural multidisciplinary 
                activities;
                  (C) supporting the development of 
                methodologies to determine the circumstances in 
                which obtaining data specific to women 
                (including data relating to the age of women 
                and the membership of women in ethnic or racial 
                groups) is an appropriate function of clinical 
                trials of treatments and therapies;
                  (D) supporting the development and expansion 
                of clinical trials of treatments and therapies 
                for which obtaining such data has been 
                determined to be an appropriate function; and
                  (E) encouraging the national research 
                institutes to conduct and support such 
                research, including such clinical trials.
  (d) Advisory Committee.--
          (1) In carrying out subsection (b), the Director of 
        the Office shall establish an advisory committee to be 
        known as the Advisory Committee on Research on Women's 
        Health (in this subsection referred to as the 
        ``Advisory Committee'').
          (2) The Advisory Committee shall be composed of no 
        fewer than 12, and not more than 18 individuals, who 
        are not officers or employees of the Federal 
        Government. The Director of NIH shall make appointments 
        to the Advisory Committee from among physicians, 
        practitioners, scientists, and other health 
        professionals, whose clinical practice, research 
        specialization, or professional expertise includes a 
        significant focus on research on women's health. A 
        majority of the members of the Advisory Committee shall 
        be women.
          (3) The Director of the Office shall serve as the 
        chair of the Advisory Committee.
          (4) The Advisory Committee shall--
                  (A) advise the Director of the Office on 
                appropriate research activities to be 
                undertaken by the national research institutes 
                with respect to--
                          (i) research on women's health;
                          (ii) research on gender differences 
                        in clinical drug trials, including 
                        responses to pharmacological drugs;
                          (iii) research on gender differences 
                        in disease etiology, course, and 
                        treatment;
                          (iv) research on obstetrical and 
                        gynecological health conditions, 
                        diseases, and treatments, including 
                        maternal mortality and other maternal 
                        morbidity outcomes; and
                          (v) research on women's health 
                        conditions which require a 
                        multidisciplinary approach;
                  (B) report to the Director of the Office on 
                such research;
                  (C) provide recommendations to such Director 
                regarding activities of the Office (including 
                recommendations on the development of the 
                methodologies described in subsection (c)(4)(C) 
                and recommendations on priorities in carrying 
                out research described in subparagraph (A)); 
                and
                  (D) assist in monitoring compliance with 
                section 492B regarding the inclusion of women 
                in clinical research.
          (5)(A) The Advisory Committee shall prepare a 
        biennial report describing the activities of the 
        Committee, including findings made by the Committee 
        regarding--
                  (i) compliance with section 492B;
                  (ii) the extent of expenditures made for 
                research on women's health by the agencies of 
                the National Institutes of Health; and
                  (iii) the level of funding needed for such 
                research.
          (B) The report required in subparagraph (A) shall be 
        submitted to the Director of NIH for inclusion in the 
        report required in section 403.
  (e) Representation of Women Among Researchers.--The 
Secretary, acting through the Assistant Secretary for Personnel 
and in collaboration with the Director of the Office, shall 
determine the extent to which women are represented among 
senior physicians and scientists of the national research 
institutes and among physicians and scientists conducting 
research with funds provided by such institutes, and as 
appropriate, carry out activities to increase the extent of 
such representation.
  (f) Definitions.--For purposes of this part:
          (1) The term ``women's health conditions'', with 
        respect to women of all age, ethnic, and racial groups, 
        means all diseases, disorders, and conditions 
        (including with respect to mental health)--
                  (A) unique to, more serious, or more 
                prevalent in women;
                  (B) for which the factors of medical risk or 
                types of medical intervention are different for 
                women, or for which it is unknown whether such 
                factors or types are different for women; or
                  (C) with respect to which there has been 
                insufficient clinical research involving women 
                as subjects or insufficient clinical data on 
                women.
          (2) The term ``research on women's health'' means 
        research on women's health conditions, including 
        research on preventing such conditions.

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TITLE VII--HEALTH PROFESSIONS EDUCATION

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         PART E--HEALTH PROFESSIONS AND PUBLIC HEALTH WORKFORCE

Subpart 1--Health Professions Workforce Information and Analysis

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[SEC. 763. PEDIATRIC RHEUMATOLOGY.

  [(a) In General.--The Secretary, acting through the 
appropriate agencies, shall evaluate whether the number of 
pediatric rheumatologists is sufficient to address the health 
care needs of children with arthritis and related conditions, 
and if the Secretary determines that the number is not 
sufficient, shall develop strategies to help address the 
shortfall.
  [(b) Report to Congress.--Not later than October 1, 2001, the 
Secretary shall submit to the Congress a report describing the 
results of the evaluation under subsection (a), and as 
applicable, the strategies developed under such subsection.
  [(c) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated such sums as may be necessary for each of the 
fiscal years 2001 through 2005.]

SEC. 763. TRAINING FOR HEALTH CARE PROVIDERS.

  (a) Grant Program.--The Secretary shall establish a program 
to award grants to accredited schools of allopathic medicine, 
osteopathic medicine, and nursing, and other health 
professional training programs for the training of health care 
professionals to reduce and prevent discrimination (including 
training related to implicit and explicit biases) in the 
provision of health care services related to prenatal care, 
labor care, birthing, and postpartum care.
  (b) Eligibility.--To be eligible for a grant under subsection 
(a), an entity described in such subsection shall submit to the 
Secretary an application at such time, in such manner, and 
containing such information as the Secretary may require.
  (c) Reporting Requirement.--Each entity awarded a grant under 
this section shall periodically submit to the Secretary a 
report on the status of activities conducted using the grant, 
including a description of the impact of such training on 
patient outcomes, as applicable.
  (d) Best Practices.--The Secretary may identify and 
disseminate best practices for the training of health care 
professionals to reduce and prevent discrimination (including 
training related to implicit and explicit biases) in the 
provision of health care services related to prenatal care, 
labor care, birthing, and postpartum care.
  (e) Authorization of Appropriations.--To carry out this 
section, there is authorized to be appropriated $5,000,000 for 
each of fiscal years 2020 through 2024.

SEC. 764. RURAL MATERNAL AND OBSTETRIC CARE TRAINING DEMONSTRATION.

  (a) In General.--The Secretary shall establish a training 
demonstration program to award grants to eligible entities to 
support--
          (1) training for physicians, medical residents, 
        including family medicine and obstetrics and gynecology 
        residents, and fellows to practice maternal and 
        obstetric medicine in rural community-based settings;
          (2) training for nurse practitioners, physician 
        assistants, nurses, certified nurse midwives, home 
        visiting nurses and non-clinical home visiting 
        workforce professionals and paraprofessionals, or non-
        clinical professionals, who meet applicable State 
        training and licensing requirements, to provide 
        maternal care services in rural community-based 
        settings; and
          (3) establishing, maintaining, or improving academic 
        units or programs that--
                  (A) provide training for students or faculty, 
                including through clinical experiences and 
                research, to improve maternal care in rural 
                areas; or
                  (B) develop evidence-based practices or 
                recommendations for the design of the units or 
                programs described in subparagraph (A), 
                including curriculum content standards.
  (b) Activities.--
          (1) Training for medical residents and fellows.--A 
        recipient of a grant under subsection (a)(1)--
                  (A) shall use the grant funds--
                          (i) to plan, develop, and operate a 
                        training program to provide obstetric 
                        care in rural areas for family practice 
                        or obstetrics and gynecology residents 
                        and fellows; or
                          (ii) to train new family practice or 
                        obstetrics and gynecology residents and 
                        fellows in maternal and obstetric 
                        health care to provide and expand 
                        access to maternal and obstetric health 
                        care in rural areas; and
                  (B) may use the grant funds to provide 
                additional support for the administration of 
                the program or to meet the costs of projects to 
                establish, maintain, or improve faculty 
                development, or departments, divisions, or 
                other units necessary to implement such 
                training.
          (2) Training for other providers.--A recipient of a 
        grant under subsection (a)(2)--
                  (A) shall use the grant funds to plan, 
                develop, or operate a training program to 
                provide maternal health care services in rural, 
                community-based settings; and
                  (B) may use the grant funds to provide 
                additional support for the administration of 
                the program or to meet the costs of projects to 
                establish, maintain, or improve faculty 
                development, or departments, divisions, or 
                other units necessary to implement such 
                program.
          (3) Training program requirements.--The recipient of 
        a grant under subsection (a)(1) or (a)(2) shall ensure 
        that training programs carried out under the grant are 
        evidence-based and include instruction on--
                  (A) maternal mental health, including 
                perinatal depression and anxiety;
                  (B) maternal substance use disorder;
                  (C) social determinants of health that impact 
                individuals living in rural communities, 
                including poverty, social isolation, access to 
                nutrition, education, transportation, and 
                housing; and
                  (D) implicit bias.
  (c) Eligible Entities.--
          (1) Training for medical residents and fellows.--To 
        be eligible to receive a grant under subsection (a)(1), 
        an entity shall--
                  (A) be a consortium consisting of--
                          (i) at least one teaching health 
                        center; or
                          (ii) the sponsoring institution (or 
                        parent institution of the sponsoring 
                        institution) of--
                                  (I) an obstetrics and 
                                gynecology or family medicine 
                                residency program that is 
                                accredited by the Accreditation 
                                Council of Graduate Medical 
                                Education (or the parent 
                                institution of such a program); 
                                or
                                  (II) a fellowship in maternal 
                                or obstetric medicine, as 
                                determined appropriate by the 
                                Secretary; or
                  (B) be an entity described in subparagraph 
                (A)(ii) that provides opportunities for medical 
                residents or fellows to train in rural 
                community-based settings.
          (2) Training for other providers.--To be eligible to 
        receive a grant under subsection (a)(2), an entity 
        shall be--
                  (A) a teaching health center (as defined in 
                section 749A(f));
                  (B) a federally qualified health center (as 
                defined in section 1905(l)(2)(B) of the Social 
                Security Act);
                  (C) a community mental health center (as 
                defined in section 1861(ff)(3)(B) of the Social 
                Security Act);
                  (D) a rural health clinic (as defined in 
                section 1861(aa) of the Social Security Act);
                  (E) a freestanding birth center (as defined 
                in section 1905(l)(3) of the Social Security 
                Act); or
                  (F) an Indian Health Program or a Native 
                Hawaiian health care system (as such terms are 
                defined in section 4 of the Indian Health Care 
                Improvement Act and section 12 of the Native 
                Hawaiian Health Care Improvement Act, 
                respectively).
          (3) Academic units or programs.--To be eligible to 
        receive a grant under subsection (a)(3), an entity 
        shall be a school of medicine, a school of osteopathic 
        medicine, a school of nursing (as defined in section 
        801), a physician assistant education program, an 
        accredited public or nonprofit private hospital, an 
        accredited medical residency training program, a school 
        accredited by the Midwifery Education and Accreditation 
        Council, by the Accreditation Commission for Midwifery 
        Education, or by the American Midwifery Certification 
        Board, or a public or private nonprofit educational 
        entity which the Secretary has determined is capable of 
        carrying out such grant.
          (4) Application.--To be eligible to receive a grant 
        under subsection (a), an entity shall submit to the 
        Secretary an application at such time, in such manner, 
        and containing such information as the Secretary may 
        require, including an estimate of the amount to be 
        expended to conduct training activities under the grant 
        (including ancillary and administrative costs).
  (d) Study and Report.--
          (1) Study.--
                  (A) In general.--The Secretary, acting 
                through the Administrator of the Health 
                Resources and Services Administration, shall 
                conduct a study on the results of the 
                demonstration program under this section.
                  (B) Data submission.--Not later than 90 days 
                after the completion of the first year of the 
                training program, and each subsequent year for 
                the duration of the grant, that the program is 
                in effect, each recipient of a grant under 
                subsection (a) shall submit to the Secretary 
                such data as the Secretary may require for 
                analysis for the report described in paragraph 
                (2).
          (2) Report to congress.--Not later than 1 year after 
        receipt of the data described in paragraph (1)(B), the 
        Secretary shall submit to the Committee on Energy and 
        Commerce of the House of Representatives and the 
        Committee on Health, Education, Labor, and Pensions of 
        the Senate a report that includes--
                  (A) an analysis of the effect of the 
                demonstration program under this section on the 
                quality, quantity, and distribution of maternal 
                (including prenatal, labor and birth, and 
                postpartum) care services and the demographics 
                of the recipients of those services;
                  (B) an analysis of maternal and infant health 
                outcomes (including quality of care, morbidity, 
                and mortality) before and after implementation 
                of the program in the communities served by 
                entities participating in the demonstration; 
                and
                  (C) recommendations on whether the 
                demonstration program should be expanded.
  (e) Authorization of Appropriations.--There is authorized to 
be appropriated to carry out this section, $5,000,000 for each 
of fiscal years 2020 through 2024.

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